Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia

Abstract

Objective To characterize the prevalence of exchange transfusion (ET), clinical characteristics of infants receiving ET, and ET-associated morbidity and mortality. Study design We conducted a multicenter cohort study of infants ≥23 weeks of gestational age (GA) with hyperbilirubinemia who underwent ET within 30 days of birth from 1997 to 2016. We examined clinical characteristics and adverse events after ET. We used multivariable logistic regression to examine the association between clinical risk factors and death. Result A total of 1252 infants were included; 4% died within 7 days of ET and 6% died before discharge. Compared with infants ≥37 weeks of GA, infants ≤29 weeks of GA had greater odds of death (adjusted odds ratio [95% confidence interval] = 20. 08 [7.32, 55.07]). Conclusions Infants ≤ 29 weeks of GA had greater odds of death following ET compared with term infants. These data will support clinicians in evaluating risks and prognosis for infants who require ET.

A single-center experience on exchange transfusion therapy in 123 full-term cases of severe neonatal hyperbilirubinemia in Wuhan

“…ETT may lead to changes in the internal environment of newborns, mainly anemia, thrombocytopenia and electrolyte blood gas disorders [41]. Although severe adverse effects such as the need for respiratory support, vascular lesion, sepsis, viral infection, intraventricular hemorrhage and seizures occur following ETT with the upward trend [14,2], most adverse events returned to normal without special treatment [15,24]. In our study, the majority of these events are trivial, temporary and asymptomatic laboratory abnormalities.…”

“…Kim [17] and Yu [21] have not reported dead case in their studies. However, Wolf MF [14] described death rate within 7 days of ET was 4% and Chitty HE [25] reported total associated mortality rate was 8%. The possible reason for higher mortality rates in their studies than that in our study may be that previous studies [14,25] enrolled premature infants (gestational age < 28 weeks) in the researches besides sample size.…”

“…At the same time, ETT is a procedure with known severe complications including vascular and cardiovascular compromise, electrolyte and hematologic derangement. Furthermore, respiratory complications such as the required use of intubation and mechanical ventilation increased as well [14][15][16]. Kim [17] showed the most common adverse effects following ETT were thrombocytopenia, hypotension, and hypoxemia.…”

Exchange transfusions in severe Rh‐mediated alloimmune haemolytic disease of the foetus and newborn: a 20‐year overview on the incidence, associated risks and outcome

“…Only few studies have evaluated the changes in the use of ET over the years [ 8 , 13 , 18 , 19 , 20 , 21 ], and although accurate comparison is not possible, these studies also show an overall sharp decline in ETs in HDFN without increase in adverse events related to ET. Comparison with other centres is complicated due to various time cohorts chosen, different study populations as definitions of (severe) HDFN vary greatly, as do local phototherapy and ET protocols and guidelines.…”

“…Neonates with blood group alloimmunization caused by non‐Rh antigens were excluded as these antigens show different pathophysiological characteristics and great variation in exchange transfusion risk after birth [ 12 ]. Neonates born <35 weeks of gestation were excluded as prematurity itself is a major risk factor for hyperbilirubinaemia and ET treatment and is associated with greater odds of death following ET compared to term infants [ 13 ]. In addition, neonates who received intravenous immunoglobulins (IVIg) (n = 41) as part of a randomized controlled trial (RCT) (LIVIN trial, identifier ISRCTN14013064) between 2006 and 2010, were excluded as IVIg is not a standard practice at the LUMC.…”