Characteristics of Hyperbilirubinemic Neonates in Need of Exchange Transfusion and Their Mothers

Document Type : Original Article


1 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Islamic Azad University, Mashhad Branch, Mashhad, Iran


Background: Severe hyperbilirubinemia is potentially neurotoxic and can lead to long-term complications in
neonates. Exchange transfusion (ECT) is one of the most important treatments for hyperbilirubinemia. In this
regard, the present study aimed to determine the characteristics of hyperbilirubinemic neonates who need ECT and
their mothers.
Methods: This cross-sectional study was performed on 380 infants born after 35 weeks of gestation who were 2-14
days old. The studied neonates had bilirubin levels higher than 17 mg/dl and underwent ECT in Ghaem Hospital in
Mashhad, Iran during 2010-20. Moreover, it should be noted that the participants were selected using the convenience
sampling method and the required data were collected using a checklist. This checklist was designed based on the
neonatal examination, maternal (maternal age, parity), and neonatal status (age, gender, and weight) and serial
laboratory tests before and after ECT (total bilirubin, hematocrit, and platelet). Finally, these variables were compared
based on the cause of hyperbilirubinemia.
Results: The mean levels of serum bilirubin were 28.5 mg/dl and 26.5 mg/dl in male and female infants (P=0.096),
respectively. Furthermore, the mean levels of serum bilirubin in neonates born by cesarean section and normal vaginal
delivery were 29.5 and 28.1 mg/dl, respectively (P=0.458). Based on the findings, 60% of the neonates suffered from
weight loss and 22% had more than 3% daily weight loss. In the present study, the most prevalent risk factors among
the studied neonates were RH incompatibility, ABO incompatibility, and G6PD deficiency, in that order.
Conclusion: Overall, these findings suggest that normal vaginal delivery, repeated breastfeeding, prevention of
severe weight loss, early detection of RH and ABO incompatibility, and G6PD deficiency, as well as appropriate
management of hyperbilirubinemia, can reduce the need for ECT and alleviate complications of neonatal


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