Complications and Outcome of Exchange Blood Transfusion in Neonatal Unconjugated Hyperbillirubinemia
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- Category: Vol. 77, June 2009
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Complications and Outcome of Exchange Blood Transfusion in Neonatal Unconjugated Hyperbillirubinemia,MOHAMAD HASHEM, AMANY E. EL-WAN, NOURAN F. HASSAN and MOHAMAD ABDOU
Abstract
Introduction: Neonatal jaundice is a common neonatal problem, usually have a benign course however in certain unmonitored and untreated conditions, unconjugated hyper-billirubinemia can progress to acute bilirubin encephalopathy, exchange blood transfusion although rarely used now in developed countries still commonly used in developing coun-tries.
Aim of the Work: To assess complications of exchange blood transfusion (EBT) for hyperbillirubinemia, also to study its incidence with exploration of cases with Kernicterus in neonatal intensive care unit (NICU), new children hospital Cairo University.
Patient and Method: A retrospective study in the NICU, new children hospital Cairo University, where data of all cases with neonatal hyperbillirubinemia who were underwent (EBT) over one year starting the first of January – end of December 2007 were collected from patients files and analyzed.
Result: EBT accounted for (30.9%) of NICU cases with neonatal jaundice, 43.8% were females and 56.2% were males, 72.6% delivered by NVD with mean gestational age 37.36±1.67 weeks, the mean age at presentation was 5.4 days ±2.9 (1-20) and the mean body weight was 2.73±0.54kg. ABO incompatibility accounted for 51.9% of causes of jaundice and no cause can be determined in 27.4% of cases, Kernicterus was recorded in 18 cases 8.6%, pre-exchange bilirubin level was the most important determinant factor with (p value 0.000). Complications of EBT included hypoglycaemia (10.09%), hypocalcaemia (25.5%), hyponatremia (6.3%), hypernatremia (3.84%), Hypokalemia (5.3%) and hyperkalemia (5.3%). Thrombocytopenia was recorded in (28.36%), cholesta-sis in ( 9.6%). NEC (0.5%), sepsis (18.3%). Mortality was recorded in 14 cases (6.7%) and it was correlated with GA and age at presentation with (p value 0.03) for both, mortality was more common among kernicteric group with (p value 0.02).
Conclusion: Incidence of neonatal jaundice among NICU is high, exchange blood transfusion was done more frequently which could be explained by relative late presentation with high mean bilirubin level causes of severe neonatal hyperbil-lirubinemia were undetermined in 27.4% complication of EBT included, electrolytes disturbances, thrombocytopenia
and cholestasis, major complications included NEC, sepsis and death. Kernicterus still recorded in NICU with bad outcome and the most important determinant factor for it is a pre-exchange bilirubin level.