Exchange transfusion for neonatal jaundice

The primary objective of this systematic review is to answer the question: Is EBT a safe and effective treatment for severe neonatal hyperbilirubinaemia?
To answer this question in general terms, safety and efficacy data (see below) will be evaluated from clinical trials comparing EBT with either no treatment or with phototherapy and simple blood transfusion. To assess the safety and efficacy of EBT in specific clinical situations, the following sub-group analyses will be performed: EBT in infants without haemolysis, EBT in preterm infants, EBT performed when SBR <350 micromoles/L (early EBT), EBT in infants with established kernicterus.

The secondary objective of this systematic review is to answer the question: What is the preferred technique for performing EBT?
To answer this question, safety and efficacy data from clinical trials will be examined in which all infants received EBT, but in which the study groups differed by some technical aspect of EBT. Because of the many areas of controversy (see Background), data on the following comparisons will be examined:

  • Blood product: Fresh whole blood vs packed red blood cells
  • Diluent for packed red blood cells: Albumin vs fresh frozen plasma vs normal saline
  • Technique: Continuous using two catheters vs 'push-pull' using one
  • Aliquot size: <5 mL/kg vs > or equal to 5 mL/kg
  • Catheter site: central vs peripheral
  • Albumin: pre-EBT albumin vs none

This is a protocol.

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