Outcomes of Neonatal Exchange Transfusion – 11 Year Experience

Presented at the Neonatal Society 2010 Spring Meeting.

Chandra P¹, Ewer AK^1,2, Rasiah SV¹

¹ Department of Neonatology, Birmingham Women’s Foundation NHS Trust, Birmingham UK
² School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, UK

Background: There are limited data on the outcome of babies following exchange transfusions (ExT). Our study, conducted at a regional centre for maternal alloimmunisation, describes outcome in babies who had ExT over an eleven-year period.

Aim: To review and define outcomes in babies who received ExT.

Methods: All babies receiving ExT between 01/01/96 to 31/12/06 were identified using neonatal database. Procedural, laboratory and outcome data were extracted from the case notes using a standardised proforma.

Results: 140 ExTs were performed in 108 neonates. Median gestation at birth was 36 weeks (range 29-42). 106 (98%) babies survived to discharge. Indications for ExT included jaundice in 83/140 (59%), anaemia in 56/140 (40%), and DIC in 1/140. 131/140 (94%) were double and 9/140 (6%) were single volume ExTs. 78% of ExTs were performed using UAC, 14% via UVC and 8% using peripheral arteries. In 124/140 (89%) there were no procedural complications. There were mild complications in 11/140 (8%) requiring either no or minimal intervention. ExT was abandoned in 5/140 (4%) due to difficulty in sampling or aspiration of blood. Two babies died one from complications of DIC and one as a result of hydrops. One baby developed NEC. There was a statistically significant decrease in platelet count and serum calcium levels but only 3 needed platelet transfusion and none needed calcium. Of the 106 babies surviving to discharge, 94 were followed up to at least one year. One died at 5 months (SIDS) and 11 were transferred elsewhere. 91/94 (97%) had normal hearing, vision and development. Three babies had sensori-neural deafness and speech delay, one baby born at 33 weeks developed spastic quadriplegia and global developmental delay. 

Conclusion: ExT has good safety profile and effective treatment outcome. In our experience, there were no significant sequelae attributable to the procedure.