A Prospective Study on Exchange Transfusion in Neonatal Unconjugated Hyperbilirubinemia in a Tertiary Care Hospital, ahmedabad, India

Background: An exchange transfusion involves replacing patient’s blood with donor blood in order to remove abnormal blood components and circulating toxins while maintaining adequate circulating blood volume. Objective: To observe the incidence, causes of jaundice requiring Exchange and any adverse event of exchange transfusion in newborns with unconjugated hyperbilirubinemia. Method: Prospective study undertaken at Neonatal Intensive Care Unit (NICU) of BJMC, Civil hospital ahmedabad from July 2015 to june 2017.Both mothers and neonates blood group and Rh typing and for all newborns pre and post exchange complete blood count with peripheral smear, serum bilirubin, haemoglobin, calcium, potassium, random blood sugar, C-reactive protein and blood culture and where ever required Direct Coombs test, reticulocyte count, G6PD activity were done. The incidence, indications, positive outcome, complications and mortality were noted. Result: Out of 1970 cases of unconjugated hyperbilirubinemia 18(0.913%) required exchange transfusion. Over all male preponderance was noted around55.55%.majority of babies who required ET was full term at birth 77.77%,while only 27.78% babies had low birth weight for their age. The mean age of neonates at presentation was 131 hours (arithmetic mean) Median age of presentation was 144 hours. Maximum no of babies presented to us after 72 hrs of birth is around 66.67%. In 11.11% of cases previous siblings were affected with unconjugated hyperbilirubinemia required ET. Rh incompatibility was the major cause 38.89% cases closely followed by ABO incompatibility 33.33% . Prior ET mean bilirubin was 31 mg/dl, who presented with in 24 hrs of birth. For those who admitted between 24 -72 hours mean bilirubin was 36.4 and 38.75 mg/dl for those who presented after 72 hrs. The complications noted were anemia (61.11%), hypocalcaemia (27.5%), sepsis 38.89%, hypoglycaemia (11.11%), seizure (22.22%), hyperkalemia (11.11%), Conclusion: Exchange transfusion is an effective procedure to decrease bilirubin levels but is associated with many complications. Rh incompatibility was one of the commonest cause of jaundice requiring Exchange transfusion.