Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. 27-32 (doi:10.1542/10.1542/peds.2006-2910)
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ARTICLE

A Decline in the Frequency of Neonatal Exchange Transfusions and Its Effect on Exchange-Related Morbidity and Mortality

Laurie A. Steiner, MD, Matthew J. Bizzarro, MD, Richard A. Ehrenkranz, MD and Patrick G. Gallagher, MD

Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut

OBJECTIVE. Our goal was to identify trends in patient demographics and indications for and complications related to neonatal exchange transfusion over a 21-year period in a single institution using a uniform protocol for performing the procedure.

METHODS. A retrospective chart review of 107 patients who underwent 141 single- or double-volume exchange transfusions from 1986–2006 was performed. Patients were stratified into 2 groups, 1986–1995 and 1996–2006, on the basis of changes in clinical practice influenced by American Academy of Pediatrics management guidelines for hyperbilirubinemia.

RESULTS. There was a marked decline in the frequency of exchange transfusions per 1000 newborn special care unit admissions over the 21-year study period. Patient demographics and indications for exchange transfusion were similar between groups. A significantly higher proportion of patients in the second time period received intravenous immunoglobulin before exchange transfusion. There was a higher proportion of patients in the 1996–2006 group with a serious underlying condition at the time of exchange transfusion. During that same time period, a lower proportion of patients experienced an adverse event related to the exchange transfusion. Although a similar percentage of patients in both groups experienced hypocalcemia and thrombocytopenia after exchange transfusion, patients treated from 1996–2006 were significantly more likely to receive calcium replacement or platelet transfusion. No deaths were related to exchange transfusion in either time period.

CONCLUSIONS. Improvements in prenatal and postnatal care have led to a sharp decline in the number of exchange transfusions performed. This decline has not led to an increase in complications despite relative inexperience with the procedure.

Key Words: exchange transfusion • hyperbilirubinemia • complication • neonate

Abbreviations: ECT—exchange transfusion • HDN—hemolytic disease of the newborn • AAP—American Academy of Pediatrics • NBSCU—newborn special care unit • YNHH—Yale New Haven Hospital • IVIg—intravenous immunoglobulin • NEC—necrotizing enterocolitis

Accepted Feb 16, 2007.


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