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.