The effect of blood exchange duration on the treatment in newborns with indirect hyperbilirubinemia

Hyperbilirubinemia is a common problem of neonatal period that has high morbidity and mortality. If the patients are not early diagnosed and not properly managed, it can cause neurological sequels or even exitus because of the bilirubin neurotoxicity. Usually phototherapy is used for the treatment, but in the cases that do not give response to phototherapy, for the patients who have very high indirect bilirubin levels and who have a high risk of neurotoxicity; blood exchange is the most effective and urgent treatment modality. Effective and early blood exchange can reduce neurological sequels.It is known that, duration for blood exchange is usually around 90 ? 120 minutes. Generally blood exchange is applied in 60 ? 90 minutes, because of the possible complications when ET is performed during a very long period or rapidly. Other than classical information, we could not find a study suggesting 120 minutes of blood exchange duration in the literature. Therefore, the aim of this study was to compare the results 90 and 120 minutes of exchange transfusion application in newborns with severe indirect hyperbilirubinemia.This study was performed at Dicle University Medical Faculty, Neonatal Intensive Care Unit between July 2007 and June 2008. A total of 36 term newborn (38 ? 42 gestational week) who were diagnosed as indirect hyperbilirubinemia with total serum bilirubin levels over 25 mg/dl were included. They were randomly assigned in two groups each of them comprise 18 babies. Exchange transfusion was performed for 90 minutes in the first group and 120 minutes for the second group. The neonates having Rh, ABO or subgroup incompatibilities, prematurity or SGA, septicemia, hypothyroidism, G6PD enzyme deficiency, intrauterine infections, diabetic mother?s baby, hemolytic disease or metabolic diseases were excluded from the study.There was no significant difference in the body weight, gestational age, postnatal age, age of mother, total bilirubin and albumin levels, the number of blood exchange and complications between two groups. The mean stay hospital days was shorter in second group compared with first group this difference did not reach to a statistically siginificant level (P>0.05). However, phototherapy duration were significantly shorter in 120 minutes transfusion group compared with 90 minutes group (P<0.001).The short duration of exchange transfusion may be an important risk for the infants due to hemodynamic alterations and bear a risk for the necessity of a second exchange. But, we couldn't confirm the influence of the exchange duration on the number of exchange transfusionsIn conclusion, our results indicated that 90 minutes may be sufficient for an effective exchange transfusion in severe hyperbilirubinemic newborn infants. However longer exchange transfusion durations may shorten the duration of phototherapy and hospital stay days and may be more cost-effective.