豊橋市民病院新生児医療センターにおける交換輸血の実態 -交換輸血の問題点・注意点に関する考察-

We conducted a survey of exchange transfusions performed in our neonatal medical center during the last 5 years.From January 1, 1996 to December 31, 2000, 2296 neonates were admitted to our neonatal nursery. Sixteen exchange transfusions were performed upon 10 infants whose birth weights ranged from 512g to 3610g. The incidence of exchange transfusion was 0.44%. The indication for each exchange transfusion was hyperbilirubinemia (eight instances), sepsis with DIC (four instances), shock with massive hemorrhage (three instances) and hydrops fetalis. Hyperkalemia was a complication in one case. Adequate blood was difficult to get in emergency situations.Exchange transfusion is one of the essential techniques in the neonatal care, although it may involve some complications including hyperkalemia, bleeding, hypocalcemia, hypoglycemia, graftversus-host disease, infections, etc., especially in very low birth weight infants. In our nursery, the incidence of exchange transfusion was very low in comparison with that of previous reports. This may represent a difference in the indication of this therapy.We propose that we should discuss the appropriate indications and safe procedures concerning exchange transfusion. We note that adequate blood supplies should be available immediately in the event of an emergency.