Investigating the Risk Factors Associated with Severe Hyperbilirubinemia in Infants with a History of Exchange Transfusion
Elham Sharifi, Samira Moradi, Soroush Shadkam, Reza Morovatshoar, Rasoul Raesi, Elaheh Abiri, Kiavash Hushmandi, Salman DaneshiIntroduction:
Exchange transfusion continues to serve as a vital and sometimes lifesaving procedure for managing severe neonatal hyperbilirubinemia, helping to avert serious longterm consequences such as kernicterus. The present study aimed to examine the key factors linked to this condition in neonates who underwent exchange transfusion at Imam Khomeini Hospital in Jiroft.
Methods:
This descriptive cross-sectional study included 26 neonates diagnosed with severe hyperbilirubinemia who required exchange transfusion during 2020–2021 through convenience sampling. Data were gathered using a researcher-developed checklist that recorded relevant variables, including Rh and ABO blood group incompatibility, glucose-6-phosphate dehydrogenase (G6PD) status, birth weight, presence of sepsis, type of feeding, birth order, infant sex, and maternal age. Statistical analyses were performed using SPSS version 22.0
Results:
The sample consisted of 26 neonates, with a mean birth weight of 2673 ± 625 grams; males accounted for 61.6% of the group. The majority of exchange transfusions (69.2%) took place between the second and seventh days of life. Exclusive breastfeeding was the most frequently observed feeding pattern among infants who required exchange transfusion, present in 96.1% of cases, followed by G6PD deficiency (11.5%), ABO incompatibility (11.5%), and Rh incompatibility (11.5%). Sepsis was noted in 7.7% of the neonates. Prior to the procedure, the mean peak serum total bilirubin level reached a high of 25.8 ± 3.2 mg/dL.
Discussion:
The findings suggest that inadequate breastfeeding practices, particularly insufficient intake during exclusive breastfeeding, were the most common contributing factors associated with severe hyperbilirubinemia requiring exchange transfusion in this cohort.
Conclusion:
Greater awareness and targeted preventive measures—such as improved lactation support, closer monitoring of at-risk infants, and timely bilirubin screening—could help lower the incidence of severe hyperbilirubinemia and, in turn, reduce the reliance on exchange transfusion among newborns.