Reduction in Exchange Transfusions for Acute Bilirubin Encephalopathy
The neonatal team at Tikur Anbessa Hospital in Addis Ababa, Ethiopia recognized they were performing exchange transfusions for acute bilirubin encephalopathy at an alarming rate, two to three times per day.
Through a failure analysis, neonatal team members and VON volunteers identified opportunities to improve identification of high-risk infants, surveillance, and monitoring efficacy of treatment.
A crucial assessment was measuring the irradiance of the fluorescent phototherapy units in the NICU with a hand-held radiometer. The team found that most of the “treatment” had been ineffective due to measured irradiances ≤ 10 µW/cm3. This discovery highlights the risk of using equipment, whether obtained through purchase or donation, without proper surveillance, maintenance and replenishment of necessary consumable supplies, such as phototherapy lightbulbs.
A pediatric trainee at the time, now Provost of St. Paul’s Hospital Millennium Medical College in Addis Ababa, Dr. Wendmagegn Gezahegn, developed a sustainable device with irradiance ≥ 30 µW/cm3, which has been effectively and consistently treating hyperbilirubinemia in Tikur Anbessa Hospital NICU patients for the past 6 years, with only one change required for the LED bulbs in this time.
"At any given time, we were preparing or performing exchange transfusions in our NICU, and counseling families that it was the only option to save their children. Now this procedure is so rare that we have to plan simulations so that trainees learn how to perform it, if ever needed." - Dr. Demtse
As the main teaching hospital in Ethiopia, a major success of this project has been the inclusion of pediatric trainees in this improvement initiative, with the lessons learned spreading across the country through the diffusion of trainees and their leadership.
By standardizing care, implementing guidelines, monitoring risk factors early, and ensuring available and efficacious first-line treatment with intensive LED phototherapy, the team at Tikur Anbessa Hospital has reduced the need to perform exchange transfusions for acute bilirubin encephalopathy to about once per month instead of multiple times per day.
Tikur Anbessa Hospital is a proud member of Vermont Oxford Network, and the Ethiopian Neonatal Network, and dedicated to learning, sharing, advocating and improving outcomes for infants and families.