Emel Okulu1, Ömer Erdeve1, Oğuz Tuncer2, Sabahattin Ertuğrul3, Hülya Özdemir4, Nukhet Aladağ Çiftdemir5, Ayşegül Zenciroğlu6, Begüm Atasay1. 1. Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey. 2. Department of Pediatrics, Division of Neonatology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey. 3. Department of Pediatrics, Division of Neonatology, Dicle University Faculty of Medicine, Diyarbakır, Turkey. 4. Department of Pediatrics, Division of Neonatology, Marmara University Faculty of Medicine, İstanbul, Turkey. 5. Department of Pediatrics, Division of Neonatology, Trakya University Faculty of Medicine, Edirne, Turkey. 6. Department of Neonatology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Abstract
Objective: The frequency of neonatal exchange transfusion has declined in recent years, but is still performed in many countries. The procedure is associated with complications. The aim of the study was to determine the clinical features and etiologies of infants with hyperbilirubinemia who underwent exchange transfusion and evaluate the adverse events and clinical outcomes. Material and Methods: We performed a secondary analysis of the multicenter Turkish Neonatal Jaundice Online Registry data. Otherwise healthy newborns born ≥35 weeks of gestation who were hospitalized for jaundice and underwent exchange transfusion were included. Results: One-hundred thirty-two patients with a mean serum bilirubin level on admission of 24.9±9.1 mg/dL were enrolled in the study. The most common cause for exchange transfusion was hemolytic jaundice (63.6%), followed by lack of proper feeding (12.9%). It was found that the infants with lack of proper feeding were discharged earlier from the maternity ward (p=0.02), but they were admitted to hospital later (p<0.001) with a higher bilirubin level (p=0.001), and geater weight loss (p=0.04). The reported rate of adverse events associated with exchange transfusion was 11.4%. The most common complication was thrombocytopenia (40%). None of the infants died during the procedure. Acute bilirubin encephalopathy was reported in 13 (9.8%) patients. Conclusion: Severe hyperbilirubinemia requiring exchange transfusion and acute bilirubin encephalopathy are still challenging problems in neonatal periodin our country. The policies including blood group analysis of pregnant women, programs informing parents about breastfeeding and jaundice, and monitoring bilirubin levels of high-risk newborns should be developed to reduce the necessitating for exchange transfusion and to avoid related complications.
Objective: The frequency of neonatal exchange transfusion has declined in recent years, but is still performed in many countries. The procedure is associated with complications. The aim of the study was to determine the clinical features and etiologies of infants with hyperbilirubinemia who underwent exchange transfusion and evaluate the adverse events and clinical outcomes. Material and Methods: We performed a secondary analysis of the multicenter Turkish Neonatal Jaundice Online Registry data. Otherwise healthy newborns born ≥35 weeks of gestation who were hospitalized for jaundice and underwent exchange transfusion were included. Results: One-hundred thirty-two patients with a mean serum bilirubin level on admission of 24.9±9.1 mg/dL were enrolled in the study. The most common cause for exchange transfusion was hemolytic jaundice (63.6%), followed by lack of proper feeding (12.9%). It was found that the infants with lack of proper feeding were discharged earlier from the maternity ward (p=0.02), but they were admitted to hospital later (p<0.001) with a higher bilirubin level (p=0.001), and geater weight loss (p=0.04). The reported rate of adverse events associated with exchange transfusion was 11.4%. The most common complication was thrombocytopenia (40%). None of the infants died during the procedure. Acute bilirubin encephalopathy was reported in 13 (9.8%) patients. Conclusion: Severe hyperbilirubinemia requiring exchange transfusion and acute bilirubin encephalopathy are still challenging problems in neonatal periodin our country. The policies including blood group analysis of pregnant women, programs informing parents about breastfeeding and jaundice, and monitoring bilirubin levels of high-risk newborns should be developed to reduce the necessitating for exchange transfusion and to avoid related complications.
Authors: Brenda E S Gibson; Audrey Todd; Irene Roberts; Derwood Pamphilon; Charles Rodeck; Paula Bolton-Maggs; Geoff Burbin; J Duguid; F Boulton; H Cohen; N Smith; D B L McClelland; M Rowley; G Turner Journal: Br J Haematol Date: 2004-02 Impact factor: 6.998