title: Severe neonatal hyperbilirubinemia leading to exchange transfusion.
abstract: BACKGROUND
  Severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. This study was conducted to investigate the causes of severe hyperbilirubinemia leading to Exchange Transfusion (ET) from March 2009 to March 2011 in Bahrami children hospital, Tehran, Iran in order to establish guidelines to prevent profound jaundice & ET.
  
  
  METHODS
  94 neonates underwent ET for severe hyperbilirubinemia data for demographic data, and onset of jaundice, history of severe hyperbilirubinemia in siblings, blood group of both mother and neonate, G6PD activity, hemoglobin, hematocrite, reticulocyte count, peripheral blood smear, total and direct bilirubin before and after ET, direct and indirect Coombs, times of transfusion and the cause of hyperbilirubinemia were all recorded for analysis.
  
  
  RESULTS
  Ninety four neonates (56.4% boys and 43.6% girls) underwent ET with a mean birth weight of 1950±40 g and a mean gestational age of 35.2±1.4 weeks. Premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD with the frequency of 59(63%), 33(35%), 25(24/5%) and 12(12.8%) were of major causes of ET.
  
  
  CONCLUSIONS
  Predisposing factors for severe hyperbilirubinemia in this study were premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD. The authors recommend prevention of premature labor, reevaluation of successful breastfeeding education for mothers and screening infants for blood group and G6PD In the first of life. Arranging earlier and continuous visits in neonates with these risk factors during the first four days of life is also recommended.
authors.affiliation: 1. Associate Professor of Department of Pediatrics, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. p.alizadet@yahoo.com.
authors.forename: Peymaneh
authors.initials: P
authors.lastname: Alizadeh Taheri
authors.affiliation: 2. Research Development Center, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. bahrami-ch@yahoo.com.
authors.forename: Mandana
authors.initials: M
authors.lastname: Sadeghi
authors.affiliation: 3. Assistant Professor of Department of Pediatrics, shariati hospital, Tehran University of Medical Sciences, Tehran, Iran. nsajjadian@yahoo.com.
authors.forename: Negar
authors.initials: N
authors.lastname: Sajjadian
keywords: Exchange transfusion; Neonatal jaundice; Severe hyperbilirubinemia