327 Excessively High Bilirubin and Exchange Transfusion in Very Low Birth Weight Infants

Abstract

Objective: To evaluate the distribution of peak serum bilirubin levels in very low birth weight (VLBW) infants and the performance of exchange transfusion in infants with excessively high bilirubin levels. Methods: A population based observational study using data collected by the Israel National VLBW Infant Database. The study sample comprised 13,499 infants of 24 to 33 weeks gestation. Two definitions of excessively high peak bilirubin levels which might be considered as threshold levels for performance of exchange transfusion were used. Firstly, a bilirubin level of ≥ 15 mg/dL for all infants (PSB-15), and secondly, incremental bilirubin levels ranging from 12-17 mg/dL according to gestational age (PSB-GA). Multivariable logistic regression analyses were performed to examine the factors associated with performance of exchange transfusion. Results: Four hundreds sixty eight (3.5%) and 1035 infants (7.7%) infants in the PSB-15 and in the PSB-GA groups respectively had peak serum bilirubin levels above thresholds for exchange transfusion. Exchange transfusion's were performed in only 66 (14.1%) of these infants in the PSB-15 group and 91 (8.8%) in the PSB-GA group. In both groups performance of exchange transfusion was significantly associated with peak serum bilirubin levels, with an odds ratio of 1.38 for each mg/dL increase above the threshold level. Conclusion: Exchange transfusion was performed in only 9-14% of VLBW infants with excessively high bilirubin levels. This may be related to an absence of definitive guidelines or the possible belief that the risks of exchange transfusion outweigh the potential risk of bilirubin induced neurological injuries.