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Systematic review of the optimal fluid for dilutional exchange transfusion in neonatal polycythaemia

¹ Department of Paediatrics, Division of Neonatology, Isala Clinics Zwolle, Zwolle, The Netherlands
² Department of Neonatology, Emma Children’s Hospital, Academic Medical Centre, Amsterdam, The Netherlands

Correspondence to:
Correspondence to:
Koert A de Waal
Department of Neonatal Medicine, Royal Prince Albert Hospital, Missenden Road, Camperdown, NSW 2050, Australia; k.a.dewaal{at}amc.uva.nl

Objectives: Several studies have shown the efficacy of dilutional exchange transfusion (DET) in reducing haematocrit (Ht) and relieving clinical symptoms in neonatal polycythaemia. We conducted a systematic review to determine the efficacy of crystalloid versus colloid solutions used in DET in an effort to identify the best solution to replace red blood cells.

Methods: The Cochrane Library, MEDLINE, and EMBASE were searched for relevant randomised controlled trials. Quality assessment and data analysis were performed using the methods and software of the Cochrane Collaboration. Relative risk (RR) and weighted mean difference (WMD) were calculated as measures of effect for categorical and continuous outcome data, respectively. Ninety five percent confidence intervals (95% CI) were calculated and a fixed effect model was used for meta-analysis.

Results: Six studies with a total of 235 newborns matched our inclusion criteria. When comparing crystalloid and colloid replacement solutions for DET, there was a clinically unimportant difference in Ht at 2–6 h and at 24 h in favour of colloidal solutions (WMD 2.29% (95% CI 1.28 to 3.31) and 1.74% (95% CI 0.80 to 2.68), respectively). This difference in post DET Ht was more evident when normal saline was compared to plasma but absent when normal saline was compared to 5% albumin.

Conclusion: There is little difference in effectiveness between plasma, 5% albumin, and crystalloid solutions. Since normal saline is cheap, readily available, and does not carry the potential risk of transfusion associated infection, normal saline is the optimal dilutional fluid for exchange transfusion in polycythaemic neonates.

Abbreviations: 95% CI, 95% confidence interval; DET, dilutional exchange transfusion; Ht, haematocrit; PC, polycythaemia; RR, relative risk; WMD, weighted mean difference

Keywords: blood viscosity; infant; newborn; plasma exchange; polycythaemia; systematic review