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Severe Neonatal Hyperbilirubinemia: Identifying Risk Factors for Exchange Transfusion in a Level IV Neonatal Intensive Care Unit

Author(s): Elisabeth Anson, Michelande Ridore, Khodayar Rais-Bahrami

Hyperbilirubinemia is one of the most common diagnoses leading to hospital admission in the newborn population.

Objective: The primary aim of this study was to identify trends in patient demographics and risk factors for hyperbilirubinemia in neonates admitted to a level IV neonatal intensive care unit with severe hyperbilirubinemia. Our secondary aim was to identify trends in patient demographics and hyperbilirubinemia risk factors among patients who received exchange transfusion(s).

Study Design: A retrospective chart review of all neonates admitted to the Children’s National Hospital Neonatal Intensive Care Unit with a primary diagnosis of hyperbilirubinemia from January 1, 2014 to December 31, 2018 was performed. Patients with a primary diagnosis of direct hyperbilirubinemia were excluded. Hospital electronic medical records were reviewed for patient demographics, record of exchange transfusion and hyperbilirubinemia risk factors. 251 charts of neonates admitted to the NICU for hyperbilirubinemia were reviewed. 221 patients met inclusion criteria.

Results: Of these 221 patients, only 9 patients required exchange transfusion (4%). Patients with a peak bilirubin ≥25 were statistically more likely to require exchange transfusion than patients with a peak bilirubin <25 (78%, p<0.001). Patients who were exclusively breastfed were less likely to require exchange transfusion (71%, p=0.01). Similarly, patients with a primary diagnosis of breastfeeding jaundice were less likely to require exchange transfusion (69%, p=0.0007). Patients with G6PD deficiency were more likely to require exchange transfusion (44%, p=0.0004). Patients requiring exchange transfusion had lower birth weights than patients who did not require exchange transfusion (2800±765g, p=0.02). Although not statistically significant, all patients who received exchange transfusions were non-white.

Conclusion: G6PD, while known to be a relatively benign condition, was associated with a risk of receiving exchange transfusion in jaundiced newborns. Newborns with severe jaundice who were exclusively breastfeed were less likely to receive exchange transfusion.

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