Management of Neonatal Hyperbilirubinemia - What is the Efficacy of Exchange Transfusion by Different Techniques?

Abstract

Background: When rapid reduction of serum bilirubin is required in neonates, exchange transfusion (ET) is the choice. Greater percentage reduction in bilirubin and less stress on the cardiovascular mechanics by isovolumetric than traditional push-pull technique has been reported. Objective: To evaluate the reduction in serum bilirubin by isovolumetric and push-pull techniques of exchange transfusion. Design: Retrospective, observational. Setting: Level II neonatal intensive care unit attached to medical college hospital. Patients: Included 114 neonates who required exchange transfusion for hyperbilirubinemia between January 2000 and December 2004. Methods: Double volume exchange transfusion was carried out for neonatal hyperbilirubinemia whenever indicated. Techniques of either isovolumetric or push-pull was chosen at the discretion of physician and the procedure was carried out over 2 hours. The pre and post-exchange bilirubin levels were noted. The percentage reduction of bilirubin at the end of exchange was determined. The efficacy of both techniques were evaluated and compared. Results: Among the total of 114 newborns, 33.3% (38/114) underwent exchange by push-pull and 66.7 % (76/114) by isovolumetric technique. Pre-exchange bilirubin levels were above 20 mg/dl in 64 (56.1%) neonates. Overall, 58.8% (67/114) had bilirubin reduction of more than 40 %. The mean drops in bilirubin are 39.9% and 41.5% by isovolumetric and push pull technique respectively. When these two techniques are compared, 59.2% in isovolumetric and 57.9% in push pull group had more than 40% reduction in bilirubin level (p=0.15). The pre-exchange bilirubin levels did not seem to influence the post-exchange drop. Conclusion: In neonatal hyperbilirubinemia, exchange transfusion reduces the bilirubin level rapidly by about 40 %. The isovolumetric and traditional push pull techniques are comparable in efficacy.