Review of exchange transfusion for neonatal hyperbilirubinenia at CMJAH from 2006 to 2011

Rugamba, Gilbert
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Background: Improvement in neonatal care has changed the features of severe hyperbilirubinemia and reduced the number of babies who need exchange transfusion (ET) to avoid bilirubin-induced neurological dysfunction. We conducted this study to determine the demographic and clinical characteristics of the exchanged babies, in order to identify their risk factors, and to determine the adverse effects and outcomes associated with ET. Methodology: This was a retrospective descriptive study, reviewing folders of infants who required ET at CMJAH from June 2006 to December 2011. Results: There were 63 patients who underwent 66 exchange transfusions. Patients exchanged in the neonatal unit accounted for 60.3%, with the rest of the patients (39.7%) being exchanged in the general ward. Preterm babies accounted for 45.7%, and the majority were inborn (44%). The majority were male (58.7%), term (54.3%), and the mean birth weight was 2.29 Kg (±0.89). The median age at exchange was 5 days (mean 4.5 days ±2.1 SD). The cause of jaundice was undetermined in most patients (84.1%), while ABO incompatibility and Rhesus disease accounted for 7.9% and 6.3%, respectively. Seven babies (11.1%) had an abnormal neurological examination before exchange and five (7.9%) were labelled as kernicterus. The mean bilirubin before exchange was 325 mmol/l ±118. The complications of ET were seen in 22.2% of patients. These were Necrotising Enterocolitis (NEC) (1.58%); seizure (1.58%); apnoea (4.76%); bleeding (3.1%); renal failure (3.1%); hypoglycaemia (4.76%); thrombocytopenia (67.6%); and hypercalcemia (85%). We had three deaths, of which two were due to neonatal sepsis acquired prior to exchange, with one case of perforated NEC in an infant with other comorbidities. Hence, the mortality associated with ET in our study was 1.5 percent. At discharge, three infants remained with signs of kernicterus (4.7%). Conclusion: Kernicterus remains a cause of concern in our settings, and mechanisms ought to be put in place to detect severe jaundice in discharged term babies who may benefit from early phototherapy (PTT) and ET; as this is shown to be a relatively safe procedure in our settings, especially in infants without other severe comorbidities. ACKNOWLEDGEMENTS I would like to take this opportunity to thank Prof Daynia Ballot, my research supervisor, who has been an inspiration for research and accepted the task of guiding me through the challenging journey of conducting and writing this review.