Role of exchange transfusion in the treatment of severe septicemia
Vain, N.E.; Mazlumian, J.R.; Swarner, O.W.; Cha, C.C.
Pediatrics 66(5): 693-697
1980
ISSN/ISBN: 0031-4005 PMID: 7432874 Document Number: 167964
Ten critically ill newborn infants presenting with documented septicemia (Streptococcus, Escherichia coli, Staphylococcus aureus, or Haemophilus influenzae) were treated with antibiotics and supportive measures that included assisted ventilation, large blood transfusions and other volume expanders, sodium bicarbonate and vasoactive drugs. Upon failure of the above treatment to improve the infants' rapidly deteriorating condition and the development of sclerema, exchange transfusions with fresh whole blood were performed and repeated up to 4 times. Of the 10 infants 7 showed immediate improvement and ultimately survived. IgM and IgA rose consistently with exchange transfusions. These infants improved following exchange transfusion probably as the result of the removal of endotoxins, improvement of perfusion and of tissue oxygenation, decrease of hemorrhagic complications and enhancement of the humoral and cellular inflammatory response. The development of sclerema in septicemic newborn infants continues to be an ominous sign despite the use of antibiotics and supportive measures. Exchange transfusions seem to decrease the mortality of this group of critically ill infants.