Abstract
Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many low- and middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical priority-setting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.
MeSH terms
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Bilirubin / analysis
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Decision Support Systems, Clinical
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Developing Countries
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Exchange Transfusion, Whole Blood / methods*
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Humans
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Hyperbilirubinemia, Neonatal* / complications
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Hyperbilirubinemia, Neonatal* / diagnosis
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Hyperbilirubinemia, Neonatal* / epidemiology
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Hyperbilirubinemia, Neonatal* / therapy
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Infant, Newborn
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Kernicterus* / diagnosis
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Kernicterus* / etiology
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Kernicterus* / prevention & control
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Models, Organizational
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Neurotoxicity Syndromes* / diagnosis
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Neurotoxicity Syndromes* / etiology
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Neurotoxicity Syndromes* / prevention & control
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Patient Care Management* / methods
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Patient Care Management* / organization & administration
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Risk Assessment / methods
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Severity of Illness Index
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Time-to-Treatment / organization & administration