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Double Volume Exchange Transfusion Clinical Pathway, ICU – History and Physical

Double Volume Exchange Transfusion Clinical Pathway — ICU

History and Physical

Assess for:

Signs of 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
    • < 3.0 g/dL GA ≥ 35 wks
    • < 2.5 g/dL GA < 35 wks
Birth History
  • Gestational age
  • Date, time, location of birth
  • Maternal blood type
  • Maternal antibody history
  • Infant blood type
  • History of intrauterine transfusions
  • Prior blood bank workup of infant at birth hospital
History
  • Prior phototherapy, IVIG
  • Feeding status, ensure NPO
  • Sepsis assessment
  • Antibiotic therapy
Physical
  • Vital signs, weight
  • General appearance
  • Hydration status
  • Abdominal
    • Hepatomegaly, splenomegaly
  • Neurologic
    • Tone, posterior arching of head, neck, spine (retrocollis, opisthotonos)
  • Skin
    • Bruising, petechiae, pallor, scalp hematoma, jaundice

 

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