Complications of Exchange Transfusion in Hospitalized Neonates in Two Neonatal Centers in Hamadan, A Five-Year Experience

Background: Exchange transfusion is commonly used in newborns for immediate treatment of severe hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus. Objectives: This study aimed to determine etiology and complications in newborns who received exchange transfusion for severe hyperbilirubinemia over the last five years. Patients and Methods: A retrospective study was performed on 28 days old infants who received exchange transfusion due to severe hyperbilirubinemia for a period of five years (from October 1st, 2006 through September 30th, 2011) in two neonatal units at Besat and Fatemieh hospitals in Hamadan, Iran. All data about patients’ demographic characteristics, causes of hyperbilirubinemia, frequency, and complications of exchange transfusion were collected from medical records and analyzed using SPSS Version 12.0). Results: Exchange transfusion was performed in 148 neonates. Eighteen patients (12.2%) received exchange transfusion twice and seventeen patients (11.4%) three times or more. Among 118 neonates 80 (54.9%) were female and the mean gestational age and birth weight were 37.2 ± 2.5 weeks and 2847 ± 699 grams, respectively. The mean maximum total serum bilirubin levels were 27. 7.6 ± 7.28 mg/dL. Hemolytic disease was found in 72 (48.6%) of newborns. The most common cause of hemolysis was ABO incompatibility in 54 (36.5%). The etiologic factors were unidentified in 61 (41.2%) neonates. Complications occurred in 57 (38.5%) neonates and the most common complications were thrombocytopenia in 26 (17.6%) and hypocalcaemia in 17 (11.5%) neonates. Mortality was found in one (0.7%) neonate. Conclusions: The etiology of exchange transfusion was unidentified in most cases; however, ABO incompatibility was the most prevalent cause of hyperbilirubinemia. Complications were common after exchange transfusion and should be considered carefully.