A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings

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.