Euroasian Journal of Hepato-Gastroenterology

Register      Login

VOLUME 11 , ISSUE 1 ( January-June, 2021 ) > List of Articles

RESEARCH ARTICLE

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

Sanjoy K Dey, Sultana Jahan, Ismat Jahan, Mohammad S Islam, Mohammad KH Shabuj, Mohammod Shahidullah

Keywords : Exchange transfusion, Neonatal hyperbilirubinemia, Prospective observational study, Term and near-term neonate

Citation Information : Dey SK, Jahan S, Jahan I, Islam MS, Shabuj MK, Shahidullah M. 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 Hepatogastroenterol 2021; 11 (1):21-26.

DOI: 10.5005/jp-journals-10018-1331

License: CC BY-NC 4.0

Published Online: 28-06-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

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.


PDF Share
  1. Yu C, Li H, Zhang Q, et al. Report about term infants with severe hyperbilirubinemia undergoing exchange transfusion in South western China during an 11 year period, from 2001 to 2011. PLoS One 2017;12(6):e0179550. DOI: 10.1371/journal. pone.0179550.
  2. Sabzehei MK, Basiri B, Shokouhi M, et al. Complications of exchange transfusion in hospitalized neonates in two neonatal centers in Hamadan, a five-year experience. J Compr Ped 2015;6(2):e20587. DOI: 10.17795/compreped-20587.
  3. Olusanya BO, Ogunlesi TA, Slusher TM. Why is kernicterus still a major cause of death and disability in low income and middle-income countries? Arch Dis Child 2014;99(12):1117–1121. DOI: 10.1136/archdischild-2013-305506.
  4. Ballot DE, Rugamba G. Exchange transfusion for neonatal hyperbilirubinemia in Johannesburg, South Africa, from 2006 to 2011. Int Sch Res Notices 2016;2016:1268149. DOI: 10.1155/2016/1268149.
  5. Jackson JC. Adverse events associated with exchange transfusion in healthy and ill newborns. Pediatrics 1997;99(5):e7. DOI: 10.1542/peds.99.5.e7.
  6. American Academy of Pediatrics. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114(1):297–316. DOI: 10.1542/peds.114.1.297.
  7. Alcock GS, Liley H. Immunoglobulin infusion for isoimmune hemolytic jaundice in neonates. Cochrane Database Syst Rev 2002;(3):CD003313. DOI: 10.1002/14651858.CD003313.
  8. Mukhopadhyay K, Murki S, Narang A, et al. Intravenous immunoglobulins in rhesus hemolytic disease. Indian J Pediatr 2003;70(9):697-699. https://doi.org/10.1007/BF02724308.
  9. Aggarwal R, Seth R, Paul VK, et al. High dose intravenous immunoglobulin therapy in the treatment of rhesus hemolytic disease. J Trop Pediatr 2002;48(2):116–117. DOI: 10.1093/tropej/48.2.116.
  10. Gottstein R, Cooke RW. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal 2003;88(1):F6–F10. DOI: 10.1136/fn.88.1.F6.
  11. Chessman JC, Bowen JR, Ford JB. Neonatal exchange transfusions in tertiary and non-tertiary hospital settings, New South Wales, 2001–2012. J Paediatr Child Health 2017;53(5):447–450. DOI: 10.1111/jpc.13504.
  12. Bujandric N, Grujic J. Exchange transfusion for severe neonatal hyperbilirubinemia: 17 years’ experience from Vojvodina, Serbia. Indian J Hematol Blood Transfus 2015;32(2):208–214. DOI: 10.1007/s12288-015-0534-1.
  13. Kakkar B, Agrawal S, Chowdhry M, et al. Exchange transfusion in neonatal hyperbilirubinemia: a single Centre experience from Northern India. Transfus Apher Sci 2019;58(6):102655. DOI: 10.1016/j.transci.2019.09.008.
  14. Sa CAM, Santos MCP, Carvalho MD, et al. Adverse events related to exchange transfusion in newborn infants with hemolytic disease: ten years of experience. Rev Paul Pediatr 2009;27(2):168–172. DOI: 10.1590/S0103-05822009000200008.
  15. Chacham S, Kumar J, Dutta S, et al. Adverse events following blood exchange transfusion for neonatal hyperbilirubinemia: a prospective study. J Clin Neonatol 2019;8(2):79–84. DOI: 10.4103/jcn.JCN_96_18.
  16. Malla T, Poudyal P, Sathian B, et al. A prospective study on exchange transfusion in neonatal unconjugated hyperbilirubinemia – in a Tertiary Care Hospital, Nepal. Kathmandu Univ Med J 2015;50(2):102–108. DOI: 10.3126/kumj.v13i2.16781.
  17. Begum S, Baki MA, Kundu G, et al. Exchange transfusion: indication and adverse effect. Bangladesh J Child Health 2012;36(1):16–19. DOI: 10.3329/bjch.v36i1.13029.
  18. Behjati Sh, Saghheb S, Aryasepehr S, et al. Adverse events associated with neonatal exchange transfusion for hyperbilirubinemia. Indian J Pediatr 2009;76(1):83–85. DOI: 10.1007/s12098-009-0033-1.
  19. Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. CMAJ 2006;175(6):587–590. DOI: 10.1503/cmaj.060328.
  20. Chitlangia M, Shah GS, Poudel P, et al. Adverse events of exchange transfusion in neonatal hyperbilirubinemia. J Nepal Paediatr Soc 2014;34(1):7–13. DOI: 10.3126/jnps.v34i1.9030.
  21. Bulbul A, Okan FF, Unsur EK, et al. Adverse events associated with exchange transfusion and etiology of severe hyperbilirubinemia in near-term and term newborns. Turk J Med Sci 2011;41(1):93–100. DOI: 10.3906/sag-0911-395.
  22. Patra K, Strofer-Isser A, Siner B, et al. Adverse events associated with neonatal exchange transfusion in the 1990s. J Pediatr 2004;144(5):626–631. DOI: 10.1016/j.jpeds.2004.01.054.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.