Clinical Profile and Outcome Following Exchange Transfusion for Neonatal Jaundice in a Tertiary Care Centre

J Trop Pediatr. 2022 Jan 7;68(1):fmac004. doi: 10.1093/tropej/fmac004.

Abstract

Introduction: Phototherapy has reduced the need for exchange transfusion (ET) to manage jaundiced neonates. Hence there are concerns about increased risk of complication due to lack of opportunity to sustain skills in performing ET. We studied the complications and treatment outcomes of neonates treated for jaundice with ET.

Methodology: A retrospective observational study was conducted from June 2013 to June 2020 in a tertiary care hospital in India. All neonates treated with ET for jaundice were included.

Results: Twenty-eight neonates underwent 31 ET during the study period. Their mean gestational age and birth weight were 37 weeks and 3200 g, respectively. Predisposing factor for jaundice observed were Coomb's positive status (11), hepatosplenomegaly suggesting hemolysis (3), cephalhematoma (2) and birth asphyxia (1). Abnormal neurological status before ET was seen in seven neonates. Adverse clinical events that happened during or within 8 h after ET were desaturation (4), tachycardia (3), tachypnea (2), bradycardia (2), shock (2) and temperature instability (2). One neonate developed acute kidney injury after ET and required peritoneal dialysis. Abnormal lab parameters observed during or within 8 h after ET were hypocalcemia (20), anemia (8), hypokalemia (7), hypernatremia (3), thrombocytopenia (3) and hyperkalemia (2). Post ET sepsis was seen in five neonates: two had only blood culture positive sepsis, two had bone and joint infection and one had liver abscess.

Conclusion: The neonates undergoing ET are at high risk of developing complications which may be life threatening. Hence careful monitoring during the procedure is needed.

Keywords: exchange transfusion; hypocalcemia; neonatal jaundice; sepsis; thrombocytopenia.

Plain language summary

Exchange transfusion is a treatment done for newborn babies with severe jaundice. This procedure is done by removing baby’s blood in small quantities and replacing it with donor’s blood. This life-saving procedure is associated with many complications. We did this study to estimate the complications associated with this procedure in our newborn unit. Twenty-eight patients underwent exchange transfusion from June 2013 to June 2020 in our hospital. We found out that temperature disturbance, abnormal heart rate, abnormal breathing and fall in oxygen levels occurred during exchange transfusion. After the procedure blood circulation disturbances, low platelet count, low blood calcium levels and low blood potassium levels were commonly observed. One patient developed renal failure after the procedure and was treated with dialysis. Five patients developed infection after the procedure and were treated with antibiotics. Thus newborn patients undergoing exchange transfusion are at high risk of developing complications which may be life threatening. Hence careful monitoring during the procedure is needed to prevent these complications.

Publication types

  • Observational Study

MeSH terms

  • Exchange Transfusion, Whole Blood / adverse effects
  • Exchange Transfusion, Whole Blood / methods
  • Humans
  • Infant, Newborn
  • Jaundice* / etiology
  • Jaundice* / therapy
  • Jaundice, Neonatal* / etiology
  • Jaundice, Neonatal* / therapy
  • Phototherapy / adverse effects
  • Tertiary Care Centers