nach oben

European Journal of Pediatrics

Erschienen in:

05.08.2021 | Original Article

The effect of exchange transfusion on mortality in neonatal sepsis: a meta-analysis

verfasst von: Sitarah Mathias, Bharathi Balachander, Ashish Bosco, Carl Britto, Suman Rao

Erschienen in: European Journal of Pediatrics | Ausgabe 1/2022

Einloggen, um Zugang zu erhalten

Abstract

Although antimicrobials are the cornerstone of neonatal sepsis management, adjunctive therapies are required to improve outcomes. The aim of our study was to evaluate the effect of exchange transfusion (ET) on mortality (primary outcome) in neonatal sepsis, as well as on immunoglobulin, complement and neutrophil levels and assess its complications (secondary outcomes). Databases searched include PubMed, NCBI, Google Scholar, CINHAL, Ovid and Scopus. Randomized controlled trials (RCTs), controlled observational studies (COSs) and uncontrolled observational studies (UOSs) reporting mortality data from using ET in neonatal sepsis were included. Studies with additional interventions, non-septic ET indications and populations aged > 28 days were excluded. Data extracted include demographics, features of study, sepsis and ET, as well as mortality rates, immunological and laboratory changes and complications. Data was meta-analysed and displayed using forest plots. The meta-analysis of 14 studies (3 RCTs, 11 COSs) revealed a mortality benefit in septic neonates who underwent ET-RR 0.72 (CI 0.61–0.86, p = 0.01) and a significant increase in pooled immunological parameters (immunoglobulin, complement levels) (SMD 1.13, [0.25, 2.02], p = 0.02) and neutrophil levels (SMD 1.07 [0.04, 2.11], p = 0.03) compared to controls. The descriptive analysis of 9 UOSs revealed thrombocytopenia as the most frequently reported complication (n = 48). Moderate–high risk of bias was largely due to inadequate sample sizes and follow-up durations.

Conclusion: Currently, the use of ET in neonatal sepsis is not directly recommended due to low certainty of evidence, inadequate power and moderate–high risk of bias and heterogeneity.

Trial registration: PROSPERO (CRD42020176629) (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=176629)

What is Known: • Exchange transfusion is one of the adjunctive methods for treatment of neonatal sepsis.
What is New: • The pooled analysis of all studies shows that exchange transfusion has a low certainty of evidence in the context of neonatal mortality. However, at this point, this intervention cannot be refuted or recommended due to heterogeneity of studies and inadequate power.

Nur mit Berechtigung zugänglich

Bohanon FJ, Nunez Lopez O, Adhikari D et al (2018) Race, income and insurance status affect neonatal sepsis mortality and healthcare resource utilization. Pediatr Infect Dis J 37:e178–e184. https://doi.org/10.1097/INF.0000000000001846CrossRefPubMedPubMedCentral

Ranjeva SL, Warf BC, Schiff SJ (2018) Economic burden of neonatal sepsis in sub-Saharan Africa. BMJ Glob Health 3. https://doi.org/10.1136/bmjgh-2017-000347

Agarwal R, Chaurasia S, Jeeva Sankar M et al (2016) Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: A cohort study. Lancet Glob Health 4:e752–e760. https://doi.org/10.1016/S2214-109X(16)30148-6CrossRef

Tarnow-Mordi W, Isaacs D, Dutta S (2010) Adjunctive immunologic interventions in neonatal sepsis. Clinics in Perinatology 37:481–499. https://doi.org/10.1016/j.clp.2009.12.002CrossRefPubMed

Falciglia HS, Greenwood CS (2013) Double volume exchange transfusion: A review of the “Ins and Outs.” In: NeoReviews. https://www.researchgate.net/publication/270456970_Double_Volume_Exchange_Transfusion_A_Review_of_the_Ins_and_Outs. Accessed 28 Jun 2020

Liberati A, Altman DG, Tetzlaff J, et al 2009 The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical research ed) 339. https://doi.org/10.1136/bmj.b2700

McMaster University, Evidence Prime Inc (2015) GRADEpro GDT: GRADEpro Guideline Development Tool [Software]

Harrer M, Cuijpers P, Furukawa TA, Ebert DD (2019) Doing meta-analysis in R: a hands-on guide. PROTECT Lab Erlangen

Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557 LP – 560. https://doi.org/10.1136/bmj.327.7414.557

10.

Ac J, Hernán MA, Reeves BC, et al (2016) The risk of bias in non-randomized studies – of Interventions (ROBINS-I) assessment tool (version for cohort-type studies) ROBINS-I tool (stage I): at protocol stage ROBINS-I tool (stage II): For each study Specify a target randomized trial specif. 1–22

11.

Pt J, Savović J, Page MJ, Sterne JAC (2019) Revised Cochrane risk-of-bias tool for randomized trials ( RoB 2 )

12.

Mathur NB, Subramanian BK, Sharma VK, Puri RK (1993) Exchange transfusion in neutropenic septicemic neonates: effect on granulocyte functions. Acta Paediatrica (Oslo, Norway: 1992) 82:939–943. https://doi.org/10.1111/j.1651-2227.1993.tb12604.x

13.

Sadana S, Mathur NB, Thakur A (1997) Exchange transfusion in septic neonates with sclerema: effect on immunoglobulin and complement levels. Indian Pediatr 34:20–25PubMed

14.

Aradhya AS, Sundaram V, Kumar P et al (2016) Double volume exchange transfusion in severe neonatal sepsis. Indian J Pediatr 83:107–113. https://doi.org/10.1007/s12098-015-1841-0CrossRefPubMed

15.

Pugni L, Ronchi A, Bizzarri B et al (2016) Exchange transfusion in the treatment of neonatal septic shock: a ten-year experience in a neonatal intensive care unit. Int J Mol Sci 17:1–12. https://doi.org/10.3390/ijms17050695CrossRef

16.

Rajput U, L.S.D (2013) Exchange transfusion in neonatal sepsis does not reduces overall mortality. J Evol Med Den Sci 2:8297–8301. https://doi.org/10.14260/jemds/1456

17.

Gunes T, Koklu E, Buyukkayhan D et al (2006) Exchange transfusion or intravenous immunoglobulin therapy as an adjunct to antibiotics for neonatal sepsis in developing countries: A pilot study. Ann Trop Paediatr 26:39–42. https://doi.org/10.1179/146532806X90592CrossRefPubMed

18.

Töllner U, Pohlandt F, Heinze F et al (1977) Treatment of septicaemia in the newborn infant: choice of initial antimicrobial drugs and the role of exchange transfusion. Acta Paediatr Scand 66:605–610. https://doi.org/10.1111/j.1651-2227.1977.tb07955.xCrossRefPubMed

19.

Prod’hom LS, Choffat JM, Frenck N et al (1974) Care of the seriously ill neonate with hyaline membrane disease and with sepsis (sclerema neonatorum). Pediatrics 53:170–181CrossRef

20.

Narayanan I, Mitter A, Gujral VV (1982) A comparative study on the value of exchange and blood transfusion in the management of severe neonatal septicemia with sclerema. Ind J Pediatr 49:519–523. https://doi.org/10.1007/BF02834557CrossRef

21.

Verma A, Pandita A, Gupta G et al (2020) Role of DVET in severe neonatal sepsis in an era of high antibiotic resistance: A retrospective observational study. J Matern-Fetal Neonatal Med 1:6. https://doi.org/10.1080/14767058.2020.1771303

22.

Togari H, Mikawa M, IWANAGA T, et al (1983) Endotoxin clearance by exchange blood transfusion in septic shock neonates. Acta Paediatr Scand 72:87–91. https://doi.org/10.1111/j.1651-2227.1983.tb09669.xCrossRef

23.

Dalvi R, Rao S, Rangnekar J, Fernandez A (1991) Exchange transfusions in neonatal sepsis. Indian pediatrics 28:39–43PubMed

24.

De Curtis M, Vetrano G, Romano G et al (2020) Improvement tetrazolium ttransfusions immunizations of phagocytosis reduction in two after preterm and nitroblue with exchange infants septicemia. 829–830

25.

Christensen RD, Hill HR, Anstall HB, Rothstein G (1984) Exchange transfusion as an alternative to granulocyte concentrate administration in neonates with bacterial sepsis and profound neutropenia. J Clin Apher 2:177–183. https://doi.org/10.1002/jca.2920020206CrossRefPubMed

26.

Vain NE, Mazlumian JR, Swarner OW, Cha CC (1980) Role of exchange transfusion in the treatment of severe septicemia. Pediatrics 66:693–697CrossRef

27.

Bossi E, Meister B, Pfenninger J (1981) Exchange transfusion for severe neonatal septicemia. Pediatrics 67:941CrossRef

28.

Kokk T, Talvik R, Zilmer M, et al (2010) Markers of oxidative stress before and after exchange transfusion for neonatal sepsis. Acta Paediatr 85:1244–1246. https://doi.org/10.1111/j.1651-2227.1996.tb18239.xCrossRef

29.

Hall R, Shigeoka A, Hill H (1983) Serum opsonic activity and peripheral neutrophil counts before and after exchange transfusion in infants with early onset group B streptococcal septicaemia. Pediatric Infectious Disease 2:356–358CrossRef

30.

Courtney SSS, Hall RR, Harris DDDD (1979) Effect of blood-transfusions on mortality in early-onset group-b streptococcal septicemia. Lancet 462

31.

Pearse SP (1978) Exchange Transfusion in treatment of severe infections in newborns and of sclerema neonatorum. Arch Dis Child 53:262. https://doi.org/10.1054/cupe.2001.0272CrossRef

32.

Belohradsky BH, Roos R, Marget W (1978) Exchange transfusion in neonatal septicemia — clinical and immunological results in vivo and in vitro. Infection 6:139–144. https://doi.org/10.1007/BF01646086CrossRef

33.

Lemos L (1981) Exchange transfusion in treatment of sepsis. Pediatrics 68:471–472CrossRef

34.

Xanthou M, Mandyla H, Photopoulos S (1985) The use of exchange transfusions, immunoglobulins and granulocyte transfusions in neonatal sepsis. In: Ross Laboratories Special Conference Washington DC

35.

Fleischmann-Struzek C, Goldfarb DM, Schlattmann P et al (2018) The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med 6:223–230CrossRef

36.

Wynn JL (2016) Defining neonatal sepsis. Curr Opin Pediatr 28:135–140. https://doi.org/10.1097/MOP.0000000000000315CrossRefPubMedPubMedCentral

37.

Pelet B, Pediatrie S De, Hospitalier C, Vaudois U (1979) Exchange transfusion in newborn infants: Effects on granulocyte function. 687–690

38.

Patra K, Storfer-Isser A, Siner B et al (2004) Adverse events associated with neonatal exchange transfusion in the 1990s. J Pediatr 144:626–631. https://doi.org/10.1016/j.jpeds.2004.01.054CrossRefPubMed

39.

Jc J (2020) Adverse events associated with exchange transfusion in healthy and ill newborns. Pediatrics

40.

Chacham S, Kumar J, Dutta S, Kumar P (2019) Adverse events following blood exchange transfusion for neonatal hyperbilirubinemia: a prospective study. J Clin Neonatol 8:79–84. https://doi.org/10.4103/jcn.JCNCrossRef

41.

Wolf MF, Childers J, Gray KD, et al (2020) Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia. J Perinatol. https://doi.org/10.1038/s41372-020-0642-0CrossRefPubMedPubMedCentral

42.

Murakami Y, Yamashita Y, Nishimi T, et al (1998) Changes of cerebral hemodynamics and oxygenation in unstable septic newborns during exchange transfusion. Kurume Med J 45:321–325. https://doi.org/10.2739/kurumemedj.45.321CrossRefPubMed

43.

Piasek CZ, Bel FV, Sola A (2014) Perfusion index in newborn infants: a noninvasive tool for neonatal monitoring. Acta Paediatr 103:468–473. https://doi.org/10.1111/apa.12574CrossRefPubMed

44.

Monin P, Vert P, Andre M, Vibert M (1979) Transcutaneous PO2 monitoring (tcPO2) in the newborn during apneic spells, convulsions, cardiac catheterizations, and exchange transfusions. Birth Defects Orig Artic Ser 15:469–491PubMed

45.

Taylor AW, Blau DM, Bassat Q, et al (2020) Initial findings from a novel population-based child mortality surveillance approach: a descriptive study. Lancet Glob Health 8:e909–e919. https://doi.org/10.1016/S2214-109X(20)30205-9CrossRefPubMedPubMedCentral

46.

Saha SK, Schrag SJ, El Arifeen S, et al (2018) Causes and incidence of community-acquired serious infections among young children in South Asia (ANISA): an observational cohort study. Lancet 392:145–159. https://doi.org/10.1016/S0140-6736(18)31127-9CrossRefPubMedPubMedCentral

47.

Andrews B, Muchemwa L, Kelly P, et al (2014) Simplified severe sepsis protocol: a randomized controlled trial of modified early goal-directed therapy in Zambia. Crit Care Med 42:2315–2324. https://doi.org/10.1097/CCM.0000000000000541CrossRefPubMedPubMedCentral

48.

Maitland K, Kiguli S, Opoka RO, et al (2011) Mortality after fluid bolus in African children with severe infection. N Engl J Med 364:2483–2495. https://doi.org/10.1056/NEJMoa1101549CrossRefPubMed

Titel: The effect of exchange transfusion on mortality in neonatal sepsis: a meta-analysis
verfasst von: Sitarah Mathias
Bharathi Balachander
Ashish Bosco
Carl Britto
Suman Rao
Publikationsdatum: 05.08.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Pediatrics / Ausgabe 1/2022
Print ISSN: 0340-6199
Elektronische ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-021-04194-w

Neu im Fachgebiet Pädiatrie

Klimaschutz beginnt bei der Wahl des Inhalators

14.05.2024 Klimawandel Podcast

Auch kleine Entscheidungen im Alltag einer Praxis können einen großen Beitrag zum Klimaschutz leisten. Die neue Leitlinie zur "klimabewussten Verordnung von Inhalativa" geht mit gutem Beispiel voran, denn der Wechsel vom klimaschädlichen Dosieraerosol zum Pulverinhalator spart viele Tonnen CO₂. Leitlinienautor PD Dr. Guido Schmiemann erklärt, warum nicht nur die Umwelt, sondern auch Patientinnen und Patienten davon profitieren.

Update Pädiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

The effect of exchange transfusion on mortality in neonatal sepsis: a meta-analysis

Abstract

Neu im Fachgebiet Pädiatrie

Klimaschutz beginnt bei der Wahl des Inhalators

Embryotransfer erhöht womöglich Leukämierisiko der Kinder

Darf man die Behandlung eines Neonazis ablehnen?

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Update Pädiatrie

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2022

Paediatric mitral valve disease - from presentation to management

Differences between genetic dilated cardiomyopathy and myocarditis in children presenting with severe cardiac dysfunction

The effect of hyperbilirubinemia on motor repertoire of infants between 3 and 5 months of age

Longitudinal associations of tobacco-related social media involvement with cigarette and e-cigarette initiation among US adolescents

State-level political partisanship strongly correlates with health outcomes for US children

Proadrenomedullin and neonatal sepsis: a systematic review and meta-analysis of diagnostic accuracy

Neu im Fachgebiet Pädiatrie

Klimaschutz beginnt bei der Wahl des Inhalators

Embryotransfer erhöht womöglich Leukämierisiko der Kinder

Darf man die Behandlung eines Neonazis ablehnen?

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Update Pädiatrie