Efficacy of exchange transfusion in the treatment of neonatal hyperbilirubinemia in Duhok and the factors affecting it

Dr. Akrem M. Atrushi

Volume : V, Issue : X, October - 2015

Efficacy of exchange transfusion in the treatment of neonatal hyperbilirubinemia in Duhok and the factors affecting it

Dr. Akrem M. Atrushi

Abstract :

 Introduction Neonatal jaundice is an in–progress problem needing hospital admission of newborns. Exchange transfusion (ET) has been known as an effective treatment for severe neonatal jaundice. Although the frequency of neonatal exchange transfusion has declined markedly in the last two decades, this procedure is still performed in many countries Aim is to shed light on the Exchange transfusion to assess the efficacy of this procedure in lowering bilirubin level and factors affecting this efficacy. Materials and Methods A cross sectional prospective study included neonates who underwent exchange transfusion for treatment of neonatal hyperbilirubinemia in Heevi Pediatric Teaching Hospital in Duhok, north of Iraq from June 2014 to June 2015. Neonates with hyperbilirubinaemia underwent urgent double volume exchange transfusion with whole blood compatible with neonate‘s and mother‘s blood. All patients had serum bilirubin levels (TSB), blood group and Rh , reticulocyte count, coomb‘s test, complete blood count, and peripheral blood film. Data collected included age, Initial serum bilirubin levels, Hematocrit, cause of hyperbilirubinemia (hemolytic or non–hemolytic) and rate of TSB lowering after the procedure, the rate of TSB change 8 hours after the procedure, the change of hematocrit after the procedure and duration of procedure were all studied. Data were analyzed statistically using SPSS 19, Fisher‘s exact test and Pearson Chi–square were P <0.05 is significant. Results The neonates were 132.The mean initial TSB is 24.34 mg/dl(SD 5.13). The mean lowering of TSB after exchange transfusion is 8.8 mg/dl(SD3.63) with a percentage of 36.15% while the initial PCV is 49.62(SD 9.6).The procedure needed to be repeated in 44 cases(33.3%). The mean duration of the procedure was 56.48 minutes(SD 12.64). The mean age at which the procedure is done is 4.48 days(SD 2.2).In 44cases(33.33%) , the cause was hemolysis. The serum bilirubin rebounded 8 hours after the procedure in77 cases (58.3%) and the hematocrit dropped in 81 cases (61.83%).The age of patients , initial serum bilirubin and duration of procedure have no significant effect on the efficacy while non hemolytic causes significantly increase the efficacy of the procedure Conclusion The mean TSB, mean hematocrit, age at which the procedure is done are comparable to other studies but the efficacy in lowering TSB is less. The procedure lowers bilirubin more effectively in non hemolytic hyperbilirubinemia.Serum bilirubin rebounds and hematocrit falls significantly after the procedure in most cases.