The Impact of Treatment Options on Neurodevelopmental Status of Neonates with Jaundice Requiring Exchange Transfusion

Introduction: Though predicting the emerging hyperbiluribincmia is the rational approach, timely exchange transfusion in significant neonatal hyperbilirubinemia is vital. The aim of this study is to evaluate the socio-demographic and clinical characteristics of newborns with significant hyperbilirubinemia, to evaluate risk factors for exchange transfusion and long-term neurodevelopmental status. Materials and Methods: Newborns who were admitted with bilirubin levels above the excahge transfusion thresholds (American Academy of Pediatrics, guideline 2004) total 104 cases were enrolled to the study. A total of 65 cases at 12-36 months were evaluated with Guide for Monitoring Child Development. The clinical and demographic characteristics, risk factors, treatment modalities, etiology of the groups and long-term neurodevelopmental status were compared between the groups with and without exchange transfusion. Results: Exchange transfusion was performed in 19 (18.3%) patients. Main factors that increase the risk of exchange transfusion were bilirubin level and bilirubin/albumin ratio. Cut-off bilirubin level and bilirubin/albumin ratio which increase the risk for cxchagc transfusion were 26.43mg/d1 and 7.43mg/g respectively. The underlying etiologies were hemolytic disease (29.8%), dehydration and breast milk jaundice (28.8%), prematurity (26.9%). Late corners (postnatal >96 hours) were more likely to have bilirubin level >= 25 mg/dl. Development delays were detected in 13.8% of 65 cases. Conclusions: Admission bilirubin level and the ratio of bilirubin to albumin was among the factors that increase the risk of exchange transfusion. Late admission with significant hyperbiluribinemia may be prevented by identification of neonates at risk for developing significant hyperbilirubinemia before discharge or early in follow-up.