title: Neonatal exchange transfusions in tertiary and non-tertiary hospital settings, New South Wales, 2001-2012.
abstract: OBJECTIVE
  To describe neonatal exchange transfusions in New South Wales (NSW) before and after release in January 2007 of a NSW Health guideline regarding exchange transfusions in tertiary and non-tertiary hospitals.
  
  
  METHODS
  The study population included neonates receiving exchange transfusion in NSW hospitals, 2001-2012. Linked birth and hospital data for mothers and babies were used to describe birth characteristics and maternal and neonatal conditions. Exchange transfusions were identified in hospital data and compared for 2001-2006 and 2007-2012. Maternal and neonatal characteristics were compared with χ2and Wilcoxon signed-rank tests.
  
  
  RESULTS
  Between 2001 and 2012, there were 286 exchange transfusions performed for 281 neonates in NSW hospitals. The number of exchange transfusions decreased from 187 in 184 neonates for 2001-2006 to 99 in 97 neonates 2007-2012 (P < 0.001). The percentage of exchange transfusions performed at tertiary hospitals increased from 85% in 2001-2006 to 91% in 2007-2012, although this was not statistically significant (P = 0.16). Most neonates requiring exchange transfusion were born in tertiary hospitals: 62% for 2001-2006 and 69% for 2007-2012. Among those born in a non-tertiary hospital, the percentage transferred or admitted to a tertiary hospital for exchange transfusion was 63% in 2001-2006 and 77% in 2007-2012.
  
  
  CONCLUSIONS
  Between 2001 and 2012, there was a decrease in neonatal exchange transfusions in NSW. After the 2007 guideline there was a non-significant increase in the proportion of exchange transfusions performed at tertiary hospitals. Although rare, exchange transfusions are still expected to occur occasionally in non-tertiary hospitals, requiring continuing support for this procedure in these settings.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia.|NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, New South Wales, Australia.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Chessman
authors.affiliation: Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia.|Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bowen
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia.|Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jane B
authors.initials: JB
authors.lastname: Ford
mesh_terms: D005078:Exchange Transfusion, Whole Blood / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009517:New South Wales; D017410:Practice Guidelines as Topic; D062606:Tertiary Care Centers / Q000592:standards* / Q000639:trends
keywords: exchange transfusion; infant; newborn; tertiary care center; whole blood