Causes of Neonatal Jaundice Requiring Exchange Transfusion

Abstract

Background: Neonatal jaundice is highly prevalent in Asia and has serious complications, such as kernicterus. Therefore, it is very important to identify the risk factors of jaundice requiring exchange transfusion since it can be helpful in the prevention of the disease and early diagnosis of its complications. Objectives: The present study aimed to identify the causes of neonatal jaundice requiring blood exchange. Methods: The present cross-sectional study was performed on 251 term and preterm neonates. The studied newborns were 2-14 days old (born at ≥ 35 weeks of gestation) with jaundice and bilirubin of more than 17 mg/dL and received exchange transfusion during 2011 - 2020 in Ghaem teaching hospital, Mashhad, Iran. The required data of the study variables, such as hyperbilirubinemia risk factors, laboratory tests, the documented history of the mothers and neonates, and physical examination results, were collected through a questionnaire and the medical records of the patients. Finally, the collected data were analyzed in SPSS software (version 20). Results: Based on the results, the mean value of the total serum bilirubin level in neonates who received exchange transfusion was 27.53 ± 10.05 mg/dL. The blood types of about 40% of mothers and their neonates were O and A/B, respectively. Moreover, 11.4% of mothers were Rh-negative; however, their neonates were Rh-positive. The results also revealed that the causes of exchange transfusion were unknown, ABO incompatibility, Rh incompatibility, glucose-6-phosphate dehydrogenase deficiency (G6PDD), and sepsis in 52.7 %, 24%, 7.1%, 5.3%, and 5.3% of the neonates, respectively. Conclusions: The findings of this study suggest that after unknown causes, the most common causes of exchange transfusion were ABO incompatibility, Rh incompatibility, G6PDD, and sepsis. Therefore, since most of these causes can be recognized, it is recommended to perform related tests and take related measures in the Midwifery Department of the hospital to prevent the occurrence and exacerbation of jaundice. Moreover, it is recommended to perform an early follow-up after the discharge.

Risk Factors of Neonatal Jaundice at Al Kadhimiya Pediatrics Hospital in Baghdad, Iraq

“…Extreme hyperbilirubinemia, defined as TSB ≥ 25 mg/dL [18] was noted in 3(1.9%) in this study , unlike a study from Taiwan [4] which had shown that (111) neonates (26.9%) of the sample were with marked hyperbilirubinemia .The Taiwanese study has shown that ABO incompatibility was the reason for neonatal hyperbirubinemia in (21.8%) of the cases .In this study 3(1.9%) of the neonatal jaundice was caused by urinary tract infections, a study from Taiwan had concluded that (0.6%) of the neonates only were diagnosed with urinary tract infection as the cause of jaundice (N=413) [4].An Iranian study had concluded that urinary tract infection causes (5.1%) of neonatal hyperbilirubinemia [6]. Although this study had shown that there was a weak, positive correlation between neonatal weight on admission and total serum bilirubin , the two authors of this study believed that this result could be due to confounding factors as other studies had shown that total serum bilirubin is inversely related to neonatal age [19] other studies had shown that although weight loss did not seemed it was the etiology of hyperbilirubinemia but the possibility that it had aggravated the jaundice is great [20,21].…”

Risk factors for exchange transfusion in neonates with unconjugated hyperbilirubinemia: A tertiary care hospital study.

“…Modalities like IVIG and anti-D administration have also demonstrated potential in raising the threshold for exchange transfusion. 15,21 The data gleaned from our neonatal unit regarding exchange transfusion underscores not only the strain on available resources but also the demand for well-trained healthcare personnel. It is imperative to devise guidelines and strategies tailored to the unique circumstances of local neonatal units, taking into account the insights garnered from our study.…”

Assistência de enfermagem em recém-nascidos com icterícia

“…Os tratamentos terapêuticos para icterícia são a fototerapia, administração de medicamentos e a exsanguinotransfusão (EXT). A recomendação do tratamento vai depender da concentração de bilirrubina no sangue do neonato (Dantas et al, 2018;Boskabadi et al, 2021). Ressaltando-se, pois, que a fototerapia de luz é o tratamento convencional comumente usadomundialmentepara o controle de icterícia, isso ocorre devido, sobretudo, à sua simplicidade de operação e resultados promissores (Pettersson et al, 2021;Freitas et al, 2022).…”