ICU Clinical Pathway for Infants Requiring
Double Volume Exchange Transfusion

 
 
Team Assessment
 
 
  • 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
 
 
 
 
 
 
 
 
 
 
Posted: July 2018
Revised: March 2025