Publication: A Prospective Study on Exchange Transfusion in Neonatal Unconjugated Hyperbilirubinemia – in a Tertiary Care Hospital, Nepal
Date
2015
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
An exchange transfusion involves replacing patient’s blood with donor blood in order
to remove abnormal blood components and circulating toxins while maintaining
adequate circulating blood volume.
Objective
To observe the incidence, causes of jaundice requiring Exchange and any adverse
event of exchange transfusion in newborns with unconjugated hyperbilirubinemia.
Method
Prospective study undertaken at Neonatal Intensive Care Unit (NICU) of Manipal
Teaching Hospital, Pokhara, Nepal from March 2014 to April 2015. For both mothers
and neonates blood group and Rh typing and for all newborns pre and post exchange
complete blood count with peripheral smear, serum bilirubin, hemoglobin, calcium,
potassium, random blood sugar, C-reactive protein and blood culture and where ever
required Direct Coombs test, reticulocyte count, G6PD activity and thyroid function
test were done. The incidence, indications, positive outcome, complications and
mortality were noted.
Result
Out of 481 cases of unconjugated hyperbilirubinemia 29(6%) required
exchange transfusion. 55.2% Pathological Jaundice [13.8% ABO incompatibility,
sepsis and hypothyroidism was commonest causes] and 44.8% exaggerated
physiological jaundice [27.6% with no underlying pathology, 10.3% preterms 3.4%
cephalhematoma] required exchange transfusion. Post transfusion, bilirubin level
decreased significantly (p<0.001). The commonest adverse events noted were
anemia (89.7% / p<0.018), hyperglycemia(51.7% / p<0.001), hypocalcaemia (48.3%
/p<0.001)), sepsis(10.3%), hypernatremia (13.8%), hyperkalaemia, bradycardia,
apnea and feed intolerance (6.9%). None of them had kernicterus and there was no
mortalities.
Conclusion
Exchange transfusion is an effective procedure to decrease bilirubin levels but is
associated with many complications. Hypothyroidism was one of the commonest
cause of jaundice requiring Exchange transfusion.
KEY WORDS
Exchange transfusion, hyperbilirubinemia, kernicterus, neonate.
Description
Malla T,1 Singh S,1 Poudyal P,2 Sathian B,3 BK G,1 Malla KK1
Department of Pediatrics
Manipal College of Medical Science Pokhara, Nepal
2Department of Pediatrics
Dhulikhel Hospital, Kathmandu University School of
Medical Sciences, Dhulikhel, Kavre, Nepal
3Department of Community Medicine
Manipal College of Medical Science Pokhara, Nepal
Keywords
Exchange transfusion, Hyperbilirubinemia, Kernicterus, Neonate