Abstract
Introduction: About 50% term and 80% preterm babies develop neonatal jaundice. Treatment to prevent bilirubin encephalopathy consists of phototherapy or exchange transfusion (ET). ET is not risk free, and mortality rates vary from 0.5 to 3.3%. Objective: To report our observations on efficacy, adverse events and factors contributing to mortality related with ET performed for the treatment of neonatal hyperbilirubinemia at a tertiary-care centre. Method : This retrospective study was conducted at the neonatology division of B.P. Koirala Institute of Health Sciences, Nepal. All neonates who required ET for jaundice from January 2013 to December 2014 were included. Results : Sixty four neonates underwent double volume ET. Predominant causes of hyperbilirubinaemia were ABO incompatibility (32.8%), Rh incompatibility (17.2%) and idiopathic (20.3%). There was a mean reduction in serum bilirubin levels to 13.1±3.82 mg/dl in the post-ET and 14.63±3.16 mg/dl in the 6 hour post-ET period. The common adverse events were hypocalcaemia in 50% and thrombocytopenia in 35.9% of neonates. Other events such as hypoglycaemia (17.2%), apnoea (18.8%) and mortality (3.1%) occurred following ET. Conclusions : ABO incompatibility was the commonest cause for ET. Most of the complications were transient. Mortality rate was 3.1% in this study.
Highlights
About 50% term and 80% preterm babies develop neonatal jaundice
There was a mean reduction in serum bilirubin levels to 13.1±3.82 mg/dl in the post-exchange transfusion (ET) and 14.63±3.16 mg/dl in the 6 hour post-ET period
ABO incompatibility was the commonest cause for ET
Summary
About 50% term and 80% preterm babies develop neonatal jaundice. Treatment to prevent bilirubin encephalopathy consists of phototherapy or exchange transfusion (ET). ET is not risk free, and mortality rates vary from 0.5 to 3.3%. About 50% of term and 80% of preterm babies develop jaundice during the neonatal period[2] but only 0.02-0.16% develop extreme hyperbilirubinaemia[3]. The serum bilirubin level varies with birth weight, gestational age, chronological age and internal milieu of the body. When total serum bilirubin level exceeds a critical limit, it crosses the blood brain barrier and results in bilirubin encephalopathy[5]. Treatment is always given to prevent bilirubin encephalopathy by phototherapy or exchange transfusion (ET)[6]. ET is considered to be a safe procedure, it is not risk free, and mortality rates vary from 0.5 to 3.3%4,7,9. ET is sufficient to minimize brain damage, despite the adverse event[11]
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