Effect of exchange blood transfusion on regional oxygenation in newborns with haemolytic disease
The article deals with studying an effect of exchange blood transfusion on regional oxygenation in 4 newborns with moderate haemolytic disease due to rhesus conflict. All four patients were born naturally, terms of gestation varied from 36 to 39 wks, and their state at birth was assessed as 8/8 to 8/9 Apgar scores. All newborns received infusion and phototherapy; by the moment of exchange blood transfusion the postnatal age of patients varied from 245 to 265 min, and total bilirubin levels from 145.7 to 168 pmol/l. Near-infrared spectroscopy (cerebral oximetry) is a safe and promising method of noninvasive continuous monitoring of regional oxygen status in the newborn based on optic spectroscopy with infrared rays from 700 to 1000 nm. In this range, a light ray, on the one hand, penetrates through the scalp, calvarium and brain tissues, and on the other, it is selectively absorbed by specific chromophore molecules. All newborns during exchange blood transfusion and 30 min after underwent monitoring of regional oximetry with the use of a cerebral oximeter. The method of «2 volume» exchange transfusion was used, when blood is withdrawn through an umbilical arterial catheter, and infusion is performed through an umbilical venous catheter. As has been found, after exchange blood transfusion fractional extraction of oxygen by brain cells decreased by 2 times - from 0.3341 (0.2468-0.4793) to 0.1457 (0.0900-0.2877), and values of regional oxygenation (cerebral oxygen saturation - crSO 2 and somatic - prSO 2) improved and were 65.5 (45.5-74.0) vs. 77.5 (66.5-84)% and 39 (30.5-50.5) vs. 49 (32.5-67.5)%, respectively. These data are indicative of the fact that exchange blood transfusion contributes to improvement of regional oxygenation in newborns with haemolytic disease, and the use of the «2 volume» technique permits to avoid undesired severe fluctuations of arterial blood pressure and cerebral blood flow. Monitoring of cerebral oxygenation during exchange blood transfusion is a safe and non-invasive method for preventing development of severe complications.