THE JOURNAL OF PEDIATRICS
www.jpeds.com
26. Nehra D, Fallon E, Carlson S, Potemkin A, Hevelone N, Mitchell P, et al. provision of a soy-based intravenous lipid emulsion at 1g/kg/d does not prevent cholestasis in neonates. JPEN J Parenter Enteral Nutr 2013;37: 498-505. 27. Ching Y, Fitzgibbons S, Valim C, Zhou J, Duggan C, Jaksic T, et al. Longterm nutritional and clinical outcomes after serial transverse enteroplasty at a single institution. J Pediatr Surg 2009;44:939. 28. National Institutes of Health. http://clinicaltrials.gov. Accessed Feb 26, 2013.
Vol. 165, No. 1 29. Carlson JJ, Kowdley KV, Sullivan SD, Ramsey SD, Veenstra DL. An evaluation of the potential cost-effectiveness of non-invasive testing strategies in the diagnosis of significant liver fibrosis. J Gastroenterol Hepatol 2009;24:786-91. 30. Shah SH, Hayes PC, Allan PL, Nicoll J, Finlayson ND. Measurement of spleen size and its relation to hypersplenism and portal hemodynamics in portal hypertension due to hepatic cirrhosis. Am J Gastroenterol 1996;91:2580-3.
50 Years Ago in THE JOURNAL OF PEDIATRICS Bilirubin Equilibration during Exchange Transfusion in Hemolytic Disease of the Newborn Sproul A, Smith L. J Pediatr 1964;65:12-26
E
xchange transfusion remains an important, if infrequently required, clinical intervention to prevent or reduce the risk of kernicterus.1 Understanding the dynamics of bilirubin removal by exchange transfusion is necessary to apply this technique optimally. The work of Sproul and Smith, using tracer dilution techniques, provided novel insights into bilirubin equilibration during double-volume exchange transfusion in infants with hemolytic disease. Their most notable observation was that extravascular bilirubin equilibration with the vascular pool during exchange transfusion is proportional to the infant’s plasma volume and an important variable in predicting the total bilirubin removed. This finding complemented the detailed observations of Valaes on bilirubin distribution and dynamics during exchange transfusion published just a few months earlier.2 These reports demonstrated that the efficacy of a double-volume exchange transfusion is for all intents and purposes, a function of the plasma volume and, most importantly, the mass of albumin, exchanged.2 It follows that donor blood of high plasma volume (ie, low hematocrit [40%]) to enhance the amount of bilirubin-free albumin introduced into the infant’s circulation during exchange2 is preferred, a practical point not necessarily highlighted in procedure manuals and textbooks today. Finally, it is worth noting that the work of Sproul and Smith was performed before the introduction of phototherapy in the US. Six of the 10 infants had ABO hemolytic disease and today likely would be successfully managed using intensive phototherapy alone, with perhaps intravenous immune globulin as a therapeutic adjunct,1 but would not require an exchange transfusion. Jon F. Watchko, MD Division of Newborn Medicine Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
References
http://dx.doi.org/10.1016/j.jpeds.2014.01.014
1. Maisels MJ, Stevenson DK, Watchko JF, McDonagh AF. Phototherapy and other treatments. In: Stevenson DK, Maisels MJ, Watchko JF, eds. Care of the jaundiced neonate. New York: McGraw-Hill; 2012. 2. Valaes T. Bilirubin distribution and dynamics of bilirubin removal by exchange transfusion. Acta Paediatr 1963;52(Suppl 149):1-115.
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www.jpeds.com
26. Nehra D, Fallon E, Carlson S, Potemkin A, Hevelone N, Mitchell P, et al. provision of a soy-based intravenous lipid emulsion at 1g/kg/d does not prevent cholestasis in neonates. JPEN J Parenter Enteral Nutr 2013;37: 498-505. 27. Ching Y, Fitzgibbons S, Valim C, Zhou J, Duggan C, Jaksic T, et al. Longterm nutritional and clinical outcomes after serial transverse enteroplasty at a single institution. J Pediatr Surg 2009;44:939. 28. National Institutes of Health. http://clinicaltrials.gov. Accessed Feb 26, 2013.
Vol. 165, No. 1 29. Carlson JJ, Kowdley KV, Sullivan SD, Ramsey SD, Veenstra DL. An evaluation of the potential cost-effectiveness of non-invasive testing strategies in the diagnosis of significant liver fibrosis. J Gastroenterol Hepatol 2009;24:786-91. 30. Shah SH, Hayes PC, Allan PL, Nicoll J, Finlayson ND. Measurement of spleen size and its relation to hypersplenism and portal hemodynamics in portal hypertension due to hepatic cirrhosis. Am J Gastroenterol 1996;91:2580-3.
50 Years Ago in THE JOURNAL OF PEDIATRICS Bilirubin Equilibration during Exchange Transfusion in Hemolytic Disease of the Newborn Sproul A, Smith L. J Pediatr 1964;65:12-26
E
xchange transfusion remains an important, if infrequently required, clinical intervention to prevent or reduce the risk of kernicterus.1 Understanding the dynamics of bilirubin removal by exchange transfusion is necessary to apply this technique optimally. The work of Sproul and Smith, using tracer dilution techniques, provided novel insights into bilirubin equilibration during double-volume exchange transfusion in infants with hemolytic disease. Their most notable observation was that extravascular bilirubin equilibration with the vascular pool during exchange transfusion is proportional to the infant’s plasma volume and an important variable in predicting the total bilirubin removed. This finding complemented the detailed observations of Valaes on bilirubin distribution and dynamics during exchange transfusion published just a few months earlier.2 These reports demonstrated that the efficacy of a double-volume exchange transfusion is for all intents and purposes, a function of the plasma volume and, most importantly, the mass of albumin, exchanged.2 It follows that donor blood of high plasma volume (ie, low hematocrit [40%]) to enhance the amount of bilirubin-free albumin introduced into the infant’s circulation during exchange2 is preferred, a practical point not necessarily highlighted in procedure manuals and textbooks today. Finally, it is worth noting that the work of Sproul and Smith was performed before the introduction of phototherapy in the US. Six of the 10 infants had ABO hemolytic disease and today likely would be successfully managed using intensive phototherapy alone, with perhaps intravenous immune globulin as a therapeutic adjunct,1 but would not require an exchange transfusion. Jon F. Watchko, MD Division of Newborn Medicine Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania
References
http://dx.doi.org/10.1016/j.jpeds.2014.01.014
1. Maisels MJ, Stevenson DK, Watchko JF, McDonagh AF. Phototherapy and other treatments. In: Stevenson DK, Maisels MJ, Watchko JF, eds. Care of the jaundiced neonate. New York: McGraw-Hill; 2012. 2. Valaes T. Bilirubin distribution and dynamics of bilirubin removal by exchange transfusion. Acta Paediatr 1963;52(Suppl 149):1-115.
64
Matsumoto et al
