Audit on neonatal exchange transfusion in the Neonatology Unit of Assiut University applying American Academy of Pediatrics 2004 guidelines

Abstract

Introduction: Exchange transfusion (ET) still has an important role in the Neonatal ICU of Assiut University Children Hospital as an emergency procedure for management of severe cases of hyperbilirubinemia. Therefore, this audit study was done on 26 patients for 1 year to detect the adherence to the American Academy of Pediatrics (AAP) 2004 guidelines, which are already implanted in the unit. The procedure involves incremental removal of the infant's blood having high bilirubin levels and/or antibody-coated red blood cells and simultaneous replacement with fresh donor blood providing fresh albumin with binding sites for bilirubin. Patients and methods: This study included 26 infants admitted at the Neonatal ICU of Assiut University Children Hospital for whom ET was done over 12 months from firstt day of September 2017 to the end of August 2018. The data were collected by recording the investigations done before and after ET and observation by the Neonatal ICU of Assiut University Children Hospital staff during ET in comparison with the checklist, which is already implanted in the unit and is based on the AAP 2004 guidelines. Results: Of the 26 studied infants, 73% had ABO incompatibility, where 19.3% had RH incompatibility and 7.7% have other diagnosed breast milk jaundice by exclusion of other causes, subgroup incompatibility, and polycythemia. Coombs test was done in 31% and not done in 69% of the studied cases. All the studied cases were given medication during ET in the form of calcium gluconate intravenously. Conclusion: AAP 2004 guidelines have been partially followed in ET in the studied cases, but there were some shortcomings that can affect the outcome. The study recommends avoiding these shortcomings.