#4080 NOVEL EXTRACORPOREAL TREATMENT FOR SEVERE NEONATAL JAUNDICE: A MATHEMATICAL MODELING STUDY WITH ALLO-HEMODIALYSIS

Abstract Background and Aims Neonate hyperbilirubinemia usually resolves within 3–5 days without complications however, severe neonatal jaundice (SNJ) is associated with long-term neurocognitive impairment, cerebral palsy, auditory neuropathy, deafness, or death. Globally, at least 481,000 term/near-term neonates are affected by SNJ annually, 114,000 dying an additional 63,000 surviving kernicterus [1,2]. Phototherapy exchange transfusions prevent/treat SNJ, but these modalities scarce in some low lower-middle income countries, where prevalence increased due to higher of glucose-6-phosphate dehydrogenase deficiency, blood group incompatibilities, late referrals, delayed diagnosis. We aimed explore a model for allo-hemodialysis (alloHD), novel potential modality treat rapidly effectively neonates, possibly avoiding transfusions. Method With alloHD, the neonate's flows through hollow fibers 0.075 m2 miniature flux hemodialyzer (pore size 1.2 2.2 nm), while healthy adult (“buddy”) counter-currently dialyzer, thus serving as “dialysate”. Our mathematical simulates bilirubin kinetics neonate buddy flow rates 15 30 mL/min, respectively. In model, conjugation was assumed be zero, resulting excess unconjugated that binds albumin causes SNJ. Bilirubin production rate were set 6 3 mg/kg/day, respectively [3]. Buddy calculated obtain normal steady state levels. only simulated because conjugated form easily excreted. Simulations performed levels 31 g/L 43 g/L, Results Model simulations suggest 3- 6-hour alloHD session can reduce >30% (Fig. 1, left panel). Due high capacity adult's liver, buddy's level increases transiently during right Conclusion modeling suggests single lower effectively. principle, this reduction should risks especially Future scenarios will incorporate improved liver function over time schedules.