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Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia

Journal of Perinatology volume 40, pages 1506–1512 (2020)Cite this article

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Abstract

Objective

To characterize the prevalence of exchange transfusion (ET), clinical characteristics of infants receiving ET, and ET-associated morbidity and mortality.

Study design

We conducted a multicenter cohort study of infants ≥23 weeks of gestational age (GA) with hyperbilirubinemia who underwent ET within 30 days of birth from 1997 to 2016. We examined clinical characteristics and adverse events after ET. We used multivariable logistic regression to examine the association between clinical risk factors and death.

Result

A total of 1252 infants were included; 4% died within 7 days of ET and 6% died before discharge. Compared with infants ≥37 weeks of GA, infants ≤29 weeks of GA had greater odds of death (adjusted odds ratio [95% confidence interval] = 20.08 [7.32, 55.07]).

Conclusions

Infants ≤ 29 weeks of GA had greater odds of death following ET compared with term infants. These data will support clinicians in evaluating risks and prognosis for infants who require ET.

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Fig. 1: Percentage of infants undergoing ET over time.

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Acknowledgements

PTN Steering Committee Members: Daniel K. Benjamin Jr., Christoph Hornik, Kanecia Zimmerman, Phyllis Kennel, and Rose Beci, Duke Clinical Research Institute, Durham, NC; Chi Dang Hornik, Duke University Medical Center, Durham, NC; Gregory L. Kearns, Scottsdale, AZ; Matthew Laughon, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ian M. Paul, Penn State College of Medicine, Hershey, PA; Janice Sullivan, University of Louisville, Louisville, KY; Kelly Wade, Children’s Hospital of Philadelphia, Philadelphia, PA; Paula Delmore, Wichita Medical Research and Education Foundation, Wichita, KS. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): Perdita Taylor-Zapata and June Lee. The Emmes Company, LLC (Data Coordinating Center): Ravinder Anand, Gaurav Sharma, Gina Simone, Kim Kaneshige, and Lawrence Taylor. PTN Publications Committee: Chaired by Thomas Green, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL

Funding

This work was funded under the National Institute of Child Health and Human Development (NICHD) contract (HHSN275201000003I) for the Pediatric Trials Network (PI Danny Benjamin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was also supported by Duke Clinical Research Institute’s R25 Summer Training in Academic Research (STAR) Program (grant #5R25HD076475-07).

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Authors and Affiliations

  1. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Mattie F. Wolf, Julie Childers, Keyaria D. Gray, Kanecia O. Zimmerman & Rachel G. Greenberg

  2. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA

    Caroline Chivily, Mike Glenn, Laila Jones, Mini Kpa, Taylor McMannen, Isaias Reyes, Kanecia O. Zimmerman & Rachel G. Greenberg

  3. Pediatrix Medical Group, Sunrise, FL, USA

    Reese H. Clark

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  1. Mattie F. Wolf
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Correspondence to Rachel G. Greenberg.

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Conflict of interest

RGG has received support from industry for research services (https://dcri.org/about-us/conflict-of-interest/). The authors have no other conflicts of interest relevant to this article to disclose.

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Wolf, M.F., Childers, J., Gray, K.D. et al. Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia. J Perinatol 40, 1506–1512 (2020). https://doi.org/10.1038/s41372-020-0642-0

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