Double Volume Exchange Transfusion in Severe Neonatal Hyperbilirubinemia: Experience from a Tertiary Care NICU in Northern India
Anjali Joshi, Jeetinder Joshi, Shivani Jain, Sriram PothapregadaBackground
Neonatal hyperbilirubinemia remains a significant clinical concern due to its association with acute bilirubin encephalopathy and long-term neurological sequelae. Double volume exchange transfusion (DVET) is implemented as a life-saving intervention when intensive phototherapy fails or when bilirubin levels reach exchange thresholds. Even though new advances have been made in neonatal care, DVET continues to be performed in tertiary care neonatal intensive care units (NICUs), especially in settings with severe hemolytic disease and cases with late presentations.
Objective
To describe the clinical characteristics, indications, procedural details, outcomes, and complications associated with DVET performed for severe neonatal hyperbilirubinemia in a tertiary care NICU.
Methods
This retrospective case series included all neonates who underwent DVET for severe hyperbilirubinemia in our tertiary care NICU over a period of 6 months. Data collected included demographic characteristics, gestational age, birth weight, hyperbilirubinemia’s etiology, pre- and post-exchange total serum bilirubin levels, procedural details, complications, and short-term outcomes, including neurological status at discharge.
Results
Our case series demonstrated a mean immediate reduction of 45.3% in TSB levels, effectively following DVET. Common etiologies included ABO incompatibility, glucose-6-phosphate dehydrogenase deficiency, Rh alloimmunization, and idiopathic causes. Complications included hypocalcemia, thrombocytopenia, and transient respiratory events. Rebound hyperbilirubinemia requiring repeat exchange occurred in three cases. There was no mortality, and two of the survivors showed persistent neurological abnormalities at discharge.
Conclusion
Double volume exchange transfusion was effective in reducing total serum bilirubin levels in neonates with severe hyperbilirubinemia but was associated with metabolic and hematologic complications.