Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia

Abstract

Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary-care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre-ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome.

Evaluation of risk factors for exchange range hyperbilirubinemia and neurotoxicity in neonates from hilly terrain of India

“…The mean period of gestation of neonates in our study was 38.3 ± 1 weeks which was identical to available studies. [ 7 8 9 ] While mean age of presentation in our study was 98 ± 49 h, available literature has reported the age of presentation in days as 4 ± 1 days, 4.9 ± 2.2 days, and 111.6 ± 66 days. [ 7 8 10 ] This wide range in age of presentation can be explained due to differences in the basic etiology underlying hyperbilirubinemia such as ABO incompatibility, G6PD deficiency, and extravasation in the form of cephalhematoma.…”

“…This was almost identical to the available literature. [ 8 9 10 ] All studies showed male preponderance among neonates with severe hyperbilirubinemia. Hence, male sex has emerged as a well recognized risk factor for exchange range hyperbilirubinemia in neonates.…”

“…Variable incidence of35.9%, 5%, 25%, 38%, 32%, 22%, and 15% has been reported in available literature. [ 5 6 7 8 9 12 13 ]…”

“…Rh incompatibility defined as DCT positivity and or evidence of hemolysis in peripheral blood film was present in 28% of patients. Studies by Bhat et al .,[ 7 ] Davutoǧlu et al .,[ 8 ] Badiee,[ 12 ] Dikshit et al .,[ 5 ] Narang et al .,[ 6 ] and Chitlangia et al .,[ 9 ] had reported Rh incompatibility in 20.6%, 12.6%, 11.7%, 10.7%, 9.2%, and 6.7%, respectively.…”

“…Among all the studies our study reflected the highest rate of Rh incompatibility in neonates reflecting geographical and racial variations. G6PD deficiency was detected in 4% of the total subjects while previous studies show rates of 19.1%, 17.2%, 11.4%, 6.2%, and 0% by Badiee,[ 12 ] Narang et al .,[ 6 ] Davutoǧlu et al .,[ 8 ] Dikshit et al .,[ 5 ] and Chitlangia et al .,[ 9 ] respectively. The percentages of neonates with G6PD deficiency remain low in our study.…”