title: Excessively high bilirubin and exchange transfusion in very low birth weight infants.
abstract: OBJECTIVE
  To evaluate the performance of exchange transfusion in very low birth weight (VLBW) infants with excessively high serum bilirubin levels.
  
  
  METHODS
  A population-based observational study using data collected by the Israel National VLBW Infant Database. The study sample comprised 13,499 infants. Two definitions of excessively high-peak bilirubin levels that might be considered as threshold levels for performance of exchange transfusion were used. First, a bilirubin level of ≥15 mg/dL for all infants (PSB-15), and second, incremental bilirubin levels ranging from 12 to 17 mg/dL according to gestational age (PSB-GA).
  
  
  RESULTS
  Four hundreds sixty-eight (3.5%) and 1035 infants (7.7%) infants in the PSB-15 and in the PSB-GA groups respectively had peak serum bilirubin levels above thresholds for exchange transfusion. Exchange transfusions were performed in 66 (14.1%) of these infants in the PSB-15 group and 91 (8.8%) in the PSB-GA group. Using logistic regression analysis, peak serum bilirubin was found as an independent factor for performing exchange transfusion.
  
  
  CONCLUSIONS
  Exchange transfusion was performed in only 9-14% of VLBW infants with excessively high bilirubin levels. We speculate that this may be a result of an absence of definitive guidelines or the possible belief that the risks of exchange transfusion outweigh the potential risk of bilirubin-induced neurological injuries.
authors.affiliation: Department of Neonatology, The Edmond and Lily Safra Children's Hospital, Tel Aviv University, Israel. kuint-j@sheba.health.gov.il
authors.forename: Jacob
authors.initials: J
authors.lastname: Kuint
authors.forename: Ayala
authors.initials: A
authors.lastname: Maayan-Metzger
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
authors.forename: Brian
authors.initials: B
authors.lastname: Reichman
mesh_terms: D016208:Databases, Factual; D005078:Exchange Transfusion, Whole Blood / Q000706:statistics & numerical data*; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome