ICU Clinical Pathway for Infants Requiring
Double Volume Exchange Transfusion
Related Pathways
Team Assessment
- History and Physical
- Hyperbilirubinemia Neurotoxicity Risk Factors
- Signs of acute bilirubin encephalopathy
- Review labs
- Total serum bilirubin (TSB) and albumin
- Signs of Acute Bilirubin Encephalopathy
- Accessing Epic Bilirubin Nomograms to determine exchange thresholds
- Gestational age ≥ 35 wks
- Exchange transfusion thresholds
- Gestational age < 35 wks
- Signs of Acute Bilirubin Encephalopathy
- Early: lethargy, hypotonia, high pitched cry, poor feeding
- Intermediate: irritability, retrocollis, opisthotonos, fever
- Advanced: apnea, stupor, coma
- Hyperbilirubinemia Neurotoxicity
Risk Factors- Isoimmune hemolytic disease
- Other hemolytic diseases
- e.g., G6PD Deficiency
- Significant clinical instability in the
previous 24 hrs:- e.g., sepsis, acidosis, asphyxia, significant lethargy, temperature instability
- Albumin
- GA ≥ 35 wks: < 3.0 g/dL
- GA < 35 wks: < 2.5 g/dL
Initiate DVET
- Pre-Procedural Labs
- Ensure blood and procedure consents obtained
- Calculate/Order Blood Products
- Gather Equipment
Posted: July 2018
Revised: March 2025
Revised: March 2025
Evidence
- Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
- Double Volume Exchange Transfusion: A Review of the "Ins and Outs"
- Adverse Events Associated with Neonatal Exchange Transfusion in the 1990's
- Blood Exchange Transfusion for Infants with Severe Neonatal Hyperbilirubinemia
- An Approach to the Management of Hyperbilirubinemia in the Preterm Infant Less Than 35 Weeks of Gestation