Characteristics of Hyperbilirubinemic Neonates in Need of Exchange Transfusion and Their Mothers

Background: Severe hyperbilirubinemia is potentially neurotoxic and can lead to long-term complications in neonates. Exchange transfusion (ECT) is one of the most important treatments for hyperbilirubinemia. In this regard, the present study aimed to determine the characteristics of hyperbilirubinemic neonates who need ECT and their mothers. Methods: This cross-sectional study was performed on 380 infants born after 35 weeks of gestation who were 2-14 days old. The studied neonates had bilirubin levels higher than 17 mg/dl and underwent ECT in Ghaem Hospital in Mashhad, Iran during 2010-20. Moreover, it should be noted that the participants were selected using the convenience sampling method and the required data were collected using a checklist. This checklist was designed based on the neonatal examination, maternal (maternal age, parity), and neonatal status (age, gender, and weight) and serial laboratory tests before and after ECT (total bilirubin, hematocrit, and platelet). Finally, these variables were compared based on the cause of hyperbilirubinemia. Results: The mean levels of serum bilirubin were 28.5 mg/dl and 26.5 mg/dl in male and female infants (P=0.096), respectively. Furthermore, the mean levels of serum bilirubin in neonates born by cesarean section and normal vaginal delivery were 29.5 and 28.1 mg/dl, respectively (P=0.458). Based on the findings, 60% of the neonates suffered from weight loss and 22% had more than 3% daily weight loss. In the present study, the most prevalent risk factors among the studied neonates were RH incompatibility, ABO incompatibility, and G6PD deficiency, in that order. Conclusion: Overall, these findings suggest that normal vaginal delivery, repeated breastfeeding, prevention of severe weight loss, early detection of RH and ABO incompatibility, and G6PD deficiency, as well as appropriate management of hyperbilirubinemia, can reduce the need for ECT and alleviate complications of neonatal hyperbilirubinemia.