Retrospective analysis of neonates who underwent exchange transfusion due to indirect hyperbilirubinemia

This study aimed to investigate the causes of jaundice, clinical features, risk factors and complications secondary to exchange transfusion in patients with indirect hyperbilirubinemia who were admitted to our hospital within a seven-year period and who underwent exchange transfusion. Material and Method: A total of 214 neonates who were hospitalized with the diagnosis of indirect hyperbilirubinemia in the Neonatal Intensive Care Unit of Yüzüncü Yıl University Faculty of Medicine between 01.05.2012 and 30.09.2019 and whose total serum bilirubin value was at or above the limit requiring exchange transfusion when admitted to the hospital were retrospectively investigated. Demographic and clinical findings in patients such as blood type of infant, blood type of mother, Rh subgroups, hemoglobin values before and after exchange transfusion, platelet count, calcium and total bilirubin values, G6PD activity, direct coombs, albumin, total bilirubin/albumin ratio, place of admission, type of birth, week of birth, gender, rank of pregnancy among others and rank of child among others who live, birthweight, presence of concurrent additional pathology, type of nutrition, weight before exchange transfusion, weight loss percentage, whether it was multiple pregnancy or not, presence of birth trauma, whether the patient received IVIG, whether the patient had a finding of acute bilirubin encephalopathy, jaundice in siblings, phototherapy, history of exchange transfusion, number of exchange transfusion, age of mother, consanguinity between mother and father, age at admission to the hospital, in which hour of the birth the exchange transfusion was performed, duration of hospital stay, type of exchange transfusion, development of a complication during or after exchange transfusion, result of metabolic panel in patients whose etiology could not be found, result of brain MRI and neurological status of the patient after exchange transfusion were investigated. SPSS software was used in data analysis. Findings: Of the patients, 55.6% were male, 60.7% were born by spontaneous vaginal delivery and mean birthweight was 2884±608 gr. When the etiologic causes were evaluated, it was found that 36% had ABO incompatibility, 27.1% had Rh incompatibility, 2.3% had ABO and Rh incompatibility, 8.8% had prematurity, 5.1% had Rh subgroup incompatibility, 2.8% had hypernatremic dehydration, 2.8% had G6PD deficiency, 1.8% had congenital hypothyroidism, and 4% had urinary tract infection, galactosemia, hereditary spherocytosis, cephalohematoma, polycythemia and sepsis. Etiology of 9.3% of the patients could not be found. Total serum bilirubin was statistically higher in infants born by SVD than in infants born by cesarean section (p:0.01). TSB values of male patients at admission were significantly higher than those of female patients (p<0.05). Hemoglobin levels and ages of patients with a hemolytic disease in their etiology were significantly lower at admission than those of patients without a hemolytic disease (p<0.01). When the durations of hospital stays were compared, the duration of hospital stay in patients with sepsis was longer than that of patients without sepsis (p<0.01). Weights at birth were compared with weights at admission and found significantly higher (p<0.01). Weights at admission to the hospital in patients who had pathological weight loss were lower and their total serum bilirubin values at admission were higher (p<0.05). The rates of weight loss in patients diagnosed with hypernatremic dehydration were significantly higher than those in patients diagnosed with other diseases (p<0.05). There was a significant fall in total serum bilirubin values at admission in patients compared to bilirubin values after phototherapy (p<0.01). Patients who were admitted to hospital late were hospitalized with statistically significantly serious hyperbilirubinemia (TSB ≥ 25 mg/dL) (p<0.01). The most common exchange transfusion complications were thrombocytopenia (26.1%), hypokalemia (24.7%), and hypercalcemia (23.8%). Two patients developed respiratory arrest during the procedure and 1 patient was exitus. The rate of mortality due to exchange transfusion was recorded as 0.5% in our study. Patients in high risk groups were admitted to hospital with lower bilirubin levels compared to the patients in medium and low risk groups (p:0.01). TSB level at admission and age at admission were significantly higher in patients admitted with acute bilirubin encephalopathy than in patients without acute bilirubin encephalopathy (p:0.01). Conclusion: Hyperbilirubinemia is still an important health problem in our country. Although exchange transfusion is an effective method in the emergency treatment of indirect hyperbilirubinemia the best treatment method in the prevention of neurological sequelae is to detect infants at risk before discharge, periodically follow them up and intervene early.