Adverse events associated with exchange transfusion and etiology of severe hyperbilirubinemia in near-term and term newborns

Aim: To assess clinical features, etiology, and complications in term and near-term newborns who received exchange transfusion. Materials and methods: Infants with >= 35 gestational weeks admitted to our neonatal intensive care unit in the first 30 days of life and underwent exchange transfusion due to severe hyperbilirubinemia between 2002 and 2008 were included. Clinical features, etiology of hyperbilirubinemia, and complications of exchange transfusion were assessed. Results: Exchange transfusion was performed 86 times in a total of 73 patients. Eleven patients received exchange transfusion twice, and 1 patient 3 times. A great proportion of the patients (61.6%) were male, and mean ( standard deviation) gestational age and birth weight of the patients were 38.0 (1.4) weeks and 3249 (619) g, respectively. While the admission, mean total serum bilirubin levels were 27.5 (7.4) mg/dL. Hemolytic disease was found in 56.1% of the newborns (n = 41). The most common causes of hemolysis were ABO incompatibility (23.2%) and Rh sensitization (12.3%). The underlying cause was not able to be identified in 29 (39.7%) cases. The most common 2 complications were hypocalcemia (n = 7) and thrombocytopenia (n = 5). Conclusion: This study implies that no etiology was defined in nearly half of the term and near term newborns who received exchange transfusion. Despite technological advances in neonatal care units in the last decade, the blood exchange-related complication rates remained the same.