The maternal and neonatal characteristics of hyperbilirubinemia in need of exchange transfusion

Background: Excessive hyperbilirubinemia is potentially neurotoxic and can lead to long-term complications in neonates. Exchange transfusion (ECT) is one of the important treatments for hyperbilirubinemia. The main goal of this study is to determine the maternal and neonatal characteristics of hyperbilirubinemia in infants in need of exchange transfusion.Methods and materials: This cross-sectional study was performed on 380 infants over 35 gestational weeks, 2 to 14 days old, with bilirubin above 17 mg/dl who had undergone ECT at Ghaem Hospital of Mashhad from 2010 to 2020. In this study, neonates in need of ECT were selected using available sampling method. The checklist form was designed based on neonatal examination, maternal (maternal age, parity), and neonatal status (age, sex, weight) and serial laboratory tests before and after ECT (total bilirubin, hematocrit, and platelet). Then, these variables were compared based on the cause of hyperbilirubinemia.Results: The mean bilirubin serum level was 28.5 mg/dl in male and 26.5 mg/dl (P = 0.096) in female infants, 29.5 mg/dl in the C-section and 28.1 mg/dl (P = 0.458) in normal vaginal delivery. Sixty percent of the neonates suffered from weight loss and 22% had more than 3% daily weight loss. In our study, infants first presented RH incompatibility and then ABO incompatibility and finally G6PD deficient neonates.Conclusion: Overall, these finding suggest that normal vaginal delivery, repeated breastfeeding, prevention of severe weight loss, early detection of RH & ABO incompatibility and G6PD deficiency, as well as appropriate management of hyperbilirubinemia may reduce both the need for ECT and alleviate complications of neonatal hyperbilirubinemia.