Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study

Abstract

A bstract Background Exchange transfusion in newborns is recommended as emergency management of hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus. Aim This study aimed to determine the frequency and document common side effects of exchange transfusion and outcomes of newborns requiring exchange transfusion. Materials and methods This prospective study was done in the Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from January 2016 to December 2019. Information was obtained regarding maternal details, newborn demographics, and clinical status. Blood grouping and Rh typing were done for both mothers and newborns. In all newborns, pre-exchange complete blood count, peripheral blood film, Coombs test, reticulocyte count, serum bilirubin and post-exchange serum bilirubin, hemoglobin, random blood sugar, serum electrolyte, and calcium were done. G6PD level was done wherever suspected. Frequency, maternal and neonatal factors, indications, and outcomes were analyzed. Results Among 839 admitted cases of unconjugated hyperbilirubinemia, 41 patients (4.9%) required exchange transfusion. Most of the babies were inborn (90.2%). Ninety-five percent of mothers received regular antenatal care; among them, 76.3% had bad obstetric history. Only 36.6% of mothers received anti-D in previous pregnancy. None had sonographic findings of hydrops. The commonest indication was Rh incompatibility (80.5%). Coombs test was positive in 58.5% of cases. Mean pre-exchange TSB was 9.44 ± 6.4, and post-exchange TSB was 4.41 ± 2.59. The commonest adverse events noted were hyperglycemia (51.2%), sepsis (19.5%), anemia requiring top-up transfusion (17.1%), and hypocalcemia (14.6%). There were no catheter-related complications. Bilirubin encephalopathy was present in 4.9% of cases. There was one mortality but not due to the procedure. Conclusion Exchange transfusion was required among 4.9% of the admitted newborns with unconjugated hyperbilirubinemia. The common adverse effects were hyperglycemia and sepsis. The commonest indication was Rh incompatibility (80.5%). Overall outcome after exchange transfusion was favorable. How to cite this article Dey SK, Jahan S, Jahan I, et al. Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study. Euroasian J Hepato-Gastroenterol 2021;11(1):21–26.

Frequency of Indirect Hyperbilirubinemia Requiring Exchange Transfusion, Etiology and its Immediate Outcome in Term Neonates in Neonatal ICU of National Institute of Child Health, Karachi

“…A similar prospective study done in Nepal which reported 6 % (29 out of 481) over a period of 14 months. 19 On the contrary ,quite decrease incidence (0.9 exchange transfusion per 1000 live birth s) was documented in south Africa by Ballot et al 16 In our study we also found that we didn't need of multiple or repeated exchange transfusion which is contrary to a study done in Bangladesh in which repeated exchange transfusion were done in 12.2 % of cases 18 Early detection of high risk cases and timely and proper management also a better quality of phototherapy may explain the zero percentage of repeated exchange transfusion in our setup.…”

“…Some researchers suggest the declining use of exchange transfusions in recent years due to its adverse effects. 18 Severe hyperbilirubinemia necessitating exchange transfusions to prevent the acute bilirubin encephalopathy which is difficult complications in the newborn. To limit the need for exchange transfusions and deter potential damaging sequelae, policies and protocols should be devised that include blood group analysis of pregnant women, programs educating parents about breastfeeding and jaundice, and monitoring bilirubin levels of highrisk neonates.…”

Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons

“…Although the frequency of ET has declined remarkably, the incidence of ET-related morbidity and mortality has not followed suit [ 38 ]. Table 1 shows the complications of ET and their incidence reported in studies conducted in the 2000s, although these are all studies on ET for neonatal hyperbilirubinemia [ 34 , 35 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. The most common complications related to ET procedures are thrombocytopenia and hypocalcemia [ 38 , 49 ].…”

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

“…Nevertheless, in neonates, it carries the potential for acute bilirubin encephalopathy or lasting neurological consequences for survivors. 3,4 Although the precise pathogenesis of neonatal hyperbilirubinemia remains elusive, it is acknowledged to arise from a confluence of perinatal and genetic factors. 5 Various therapeutic interventions, such as phototherapy, exchange transfusion (ET), intravenous immunoglobulins (IVIG), and anti-D administration to Rh-negative mothers, have been employed to manage or prevent severe hyperbilirubinemia.…”