General retrospective evoluatian of hyperbilirubinemia patients after exchange tranfusion

Background:The less common pathological jaundice compared to physiological neonatal jaundice is an important problem that can result in kernicterus if not treated early stage.It is important to evaluate neonatal jaundice together with risk factors and to apply an effective treatment method.In severe neonatal jaundice, phototherapy and exchange transfusion are the most commonly used treatment modalities. The aim of this study was to evaluate the demographic characteristics, clinical and laboratory findings of patients with severe hyperbilirubinemia. Materials and Methods:In this study, we retrospectively reviewed the files of patients who were treated with exchange transfusion in the Neonatal Intensive Care Unit of Dicle University Medical Faculty Hospital between January 2013 and December 2015.Birth place of the patients, type of birth, maternal age, parity, consanguineous marriage, family residence, gestational age, patient age at admission to hospital, complaints of patients, gender, birth weight, physical examination findings, laboratory results, duration of phototherapy, the duration of exchange transfusion, the number of exchange transfusion, and the complications after exchange transfusion were assessed. Results: A total of 48 babies, 29 (60.4%) male and 19 (39.6%) female, were included in the study in the neonatal intensive care unit for neonatal jaundice.32 (66.7%) of the babies were born normal vaginally route and 16 (33.3%) were born with ceasearean route.The mean birth weights of babies were 3134.38 ± 390.47 gr. found.The mean age of the infants was 3.69 ± 2.63 days. All of the babies had yellowing of the skin and eyes. In addition to jaundice, it was determined that 10 infants complained of hassle and 4 children had complaints of groaning. It was learned that 37 (90.2%) of the patients were born in the hospital and 4 (9.8%) were born at home. The mean age of the mothers was 29.56 ± 6.26 years (18-45) and the total number of pregnancies was 4 ± 2 and the mean total number of births was 3 ± 2 births. When the consanguineous marriage was questioned in parents, it was found that there was no relationship in 25 (52.1%), 8 (16.7%) had consanguineous marriages and 15 (31.2%) had no information about relationship status between mothers and fathers. The mean hemoglobin value of the patients during hospital admission was 13.9 ± 3.79 g / dL, the mean hematoctrit value was 41.93 ± 11.12 (%), the mean total leukocyte count was 17.72 ± 8.73 (x103 / mm3), and the mean platelet count was 258.33 ± 97.16 (x103 / mm3). was found.The mean urea value of patients was 48.92 ± 38.59 mg / dL, creatinine; 0.72 ± 0.42 mg / dL, average sodium; 141.83 ± 8.26 mEq / L and an average potassium value of 4.69 ± 0.84 mEq / L. Mean CRP values ​​of the patients were 0.34 ± 0.42 mg / dL.When the patients were examined for the etiology of jaundice; 10 patients (20.8%) had AB0 incompatibility and 8 patients (16.7%) had Rh incompatibility. When the brain MRI examinations of newborns who underwent exchange transfusion were evaluated; 2 (4.2%) patients were found to be normal MRI results, 5 (10.4%) had MRI findings consistent with cernicterus and 37 (77.1%) had no brain MRI result. The mean duration of phototherapy was 4 ± 1.9 days. 46 (95.8%) infants were treated with exchange transfusion once, whereas only 2 (4.2%) infants had to be treated with exchange transfusion for the second time. Negative and moderate correlations were found with decreases in total bilirubin and indirect bilirubin levels after the admission of newborns at the time of admission (p = 0.001 and p <0.001, respectively). However, there was no significant relationship between the duration of hospital stay, the amount of exchange transfusion blood volume, the duration of exchange transfusion and the duration of phototherapy and the decrease in bilirubin levels (p> 0.05). Of the patients, 3 (6.3%) died afterexchange transfusion. Conclusions:Pathological hyperbilirubinemia is still an important health problem. It should be known that hyperbilirubinemia is one of the major emergencies of newborns. Risky infants should be identified and followed up closely. Despite the qualitative and quantitative rapid development of neonatal intensive care units, the rate of blood exchange due to hyperbilirubunemia is high. We believe that the regional education programs should be organized and necessary information should be provided to the health personnel and families, and the rate of bilirubin encephalopathy and exchange transfusion rates can be reduced with the early diagnosis and treatment approach. If it is delayed, it may result in chronic encephalopathy (kernicterus). Hyperbilirubinemia is one of the emergencies of newborns. It is important that all neonates are closely monitored for hyperbilirubinemia risks. Keywords: acute complications, exchange transfusion, kernicterus, newborn jaundice