Exchange transfusion in neonatal hyperbilirubinemia.

Four hundred and thirty three exchange transfusions (ET) for neonatal hyperbilirubinemia in 225 full term (Group I) and 110 premature/low birth weight (Group II) babies were analyzed. A total of 78.5% cases required one, 15.22% two, 4.8% three and 1.5% four ET. In Group I ABO HDN (35.94%), Rh HDN (10.7%), septicemia (8.9%), and G-6-PD deficiency (6.2%) were the major causes. Nearly 20% had multiple factors and in 9.3% no cause was identified. In multifactorial cases 13.3% had septicemia, 17.3% ABO HDN and 6.2% Rh HDN in various combinations. Common causes in Group II babies were septicemia (20.9%), ABO HDN (19.07%), Rh HDN (6.4%) and G-6-PD deficiency (5.4%). Nearly 8% had multifactorial etiology while 30.9% were idiopathic. Complications occurred in 20.4% Group I and 41.8% in Group II babies during ET. Procedure related mortality was 3.2/100 ET which declined to 0.9/100 ET when high risk babies were excluded. Overall mortality in babies subjected to ET was 10.6/100 ET. Cardiorespiratory arrest during procedure (30.4%), septicemia (26.1%) and kernicterus (19.6%) were the leading causes of death. Anemia (23.5% Group I and 50.9% Group II babies) and clinical septicemia (14.2% Group I and 16.4% Group II babies) were major delayed complications.