title: A Prospective Study on Exchange Transfusion in Neonatal Unconjugated Hyperbilirubinemia--in a Tertiary Care Hospital, Nepal.
abstract: BACKGROUND
  An exchange transfusion involves replacing patient's blood with donor blood in order to remove abnormal blood components and circulating toxins while maintaining adequate circulating blood volume.
  
  
  OBJECTIVE
  To observe the incidence, causes of jaundice requiring Exchange and any adverse event of exchange transfusion in newborns with unconjugated hyperbilirubinemia.
  
  
  METHODS
  Prospective study undertaken at Neonatal Intensive Care Unit (NICU) of Manipal Teaching Hospital, Pokhara, Nepal from March 2014 to April 2015. For both mothers and neonates blood group and Rh typing and for all newborns pre and post exchange complete blood count with peripheral smear, serum bilirubin, hemoglobin, calcium, potassium, random blood sugar, C-reactive protein and blood culture and where ever required Direct Coombs test, reticulocyte count, G6PD activity and thyroid function test were done. The incidence, indications, positive outcome, complications and mortality were noted.
  
  
  RESULTS
  Out of 481 cases of unconjugated hyperbilirubinemia 29 (6%) required exchange transfusion. 55.2% Pathological Jaundice [13.8% ABO incompatibility, sepsis and hypothyroidism was commonest causes] and 44.8% exaggerated physiological jaundice [27.6% with no underlying pathology, 10.3% preterms 3.4% cephalhematoma] required exchange transfusion. Post transfusion, bilirubin level decreased significantly (p < 0.001). The commonest adverse events noted were anemia (89.7% / p < 0.018), hyperglycemia(51.7% / p < 0.001), hypocalcaemia (48.3% / p < 0.001)), sepsis(10.3%), hypernatremia (13.8%), hyperkalaemia, bradycardia, apnea and feed intolerance (6.9%). None of them had kernicterus and there was no mortalities.
  
  
  CONCLUSIONS
  Exchange transfusion is an effective procedure to decrease bilirubin levels but is associated with many complications. Hypothyroidism was one of the commonest cause of jaundice requiring Exchange transfusion.
authors.affiliation: Department of Pediatrics Manipal College of Medical Science Pokhara, Nepal.
authors.forename: T
authors.initials: T
authors.lastname: Malla
authors.affiliation: Department of Pediatrics Manipal College of Medical Science Pokhara, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Pediatrics Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
authors.forename: P
authors.initials: P
authors.lastname: Poudyal
authors.affiliation: Department of Community Medicine Manipal College of Medical Science Pokhara, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Sathian
authors.affiliation: Department of Pediatrics Manipal College of Medical Science Pokhara, Nepal.
authors.forename: G
authors.initials: G
authors.lastname: Bk
authors.affiliation: Department of Pediatrics Manipal College of Medical Science Pokhara, Nepal.
authors.forename: K K
authors.initials: KK
authors.lastname: Malla
mesh_terms: D000017:ABO Blood-Group System; D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects / Q000379:methods*; D006403:Hematologic Tests; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications / Q000628:therapy*; D007231:Infant, Newborn; D007565:Jaundice / Q000209:etiology / Q000628:therapy; D008297:Male; D009390:Nepal; D011446:Prospective Studies; D012204:Rh-Hr Blood-Group System; D063128:Tertiary Health Care
chemical_list: D000017:ABO Blood-Group System; D012204:Rh-Hr Blood-Group System