Causes of Neonatal Jaundice Requiring Exchange Transfusion

Background: Neonatal jaundice is highly prevalent in Asia and has serious complications, such as kernicterus. Therefore, it is very important to identify the risk factors of jaundice requiring exchange transfusion since it can be helpful in the prevention of the disease and early diagnosis of its complications. Objectives: The present study aimed to identify the causes of neonatal jaundice requiring blood exchange. Methods: The present cross-sectional study was performed on 251 term and preterm neonates. The studied newborns were 2-14 days old (born at ≥ 35 weeks of gestation) with jaundice and bilirubin of more than 17 mg/dL and received exchange transfusion during 2011 - 2020 in Ghaem teaching hospital, Mashhad, Iran. The required data of the study variables, such as hyperbilirubinemia risk factors, laboratory tests, the documented history of the mothers and neonates, and physical examination results, were collected through a questionnaire and the medical records of the patients. Finally, the collected data were analyzed in SPSS software (version 20). Results: Based on the results, the mean value of the total serum bilirubin level in neonates who received exchange transfusion was 27.53 ± 10.05 mg/dL. The blood types of about 40% of mothers and their neonates were O and A/B, respectively. Moreover, 11.4% of mothers were Rh-negative; however, their neonates were Rh-positive. The results also revealed that the causes of exchange transfusion were unknown, ABO incompatibility, Rh incompatibility, glucose-6-phosphate dehydrogenase deficiency (G6PDD), and sepsis in 52.7 %, 24%, 7.1%, 5.3%, and 5.3% of the neonates, respectively. Conclusions: The findings of this study suggest that after unknown causes, the most common causes of exchange transfusion were ABO incompatibility, Rh incompatibility, G6PDD, and sepsis. Therefore, since most of these causes can be recognized, it is recommended to perform related tests and take related measures in the Midwifery Department of the hospital to prevent the occurrence and exacerbation of jaundice. Moreover, it is recommended to perform an early follow-up after the discharge.