(P-TS-84) Observational Study of Neonatal Exchange Transfusions

Background/Case Studies: Neonatal exchange transfusions (ETs) were originally developed to treat severe hemolytic disease of the fetus and newborn (HDFN), and became the first intervention to effectively control hyperbilirubinemia and prevent kernicterus in newborns. With newer advancements in medical care, both ETs and HDFN have become less common. This study is a review of neonatal ETs performed at a single center over a 6-year period to describe the characteristics of patients undergoing ET and procedural outcomes in contemporary practice.

Study

Design/Methods: All neonatal ETs performed between 2018-2024 at one quaternary pediatric hospital were identified. Records were reviewed to abstract patient demographics, diagnosis/indication for the ET, adverse events, and outcomes.

Results/Findings: Over a 6-year period, 42 ETs were performed for 31 neonates. The median age at the time of ET was 6 days old (IQR 3 – 10 days), and patients were born at a median gestational age of 37.5 weeks (IQR 36 – 39 weeks). The most common indication for the procedure was hyperbilirubinemia (20/31, 64.5%), with 4/20 (20.0%) attributed to HDFN (Table 1). The following antibodies were implicated in the cases of HDFN: (1) anti-C and anti-D; (2) anti-S; (3) anti-c; (4) anti-E. None of the HDFN cases involved ABO incompatibility.



Other indications for ET included suspicion for gestational alloimmune liver disease (GALD)/neonatal hemochromatosis (NH) (6/31), anemia (3/31), alpha thalassemia major (1/31), and B-ALL (1/31). 8/31 (25.8%) neonates required a repeat ET, with 3/8 then requiring a 3^rd ET. Most ETs were well-tolerated with few severe adverse events noted. Frequent adverse events included thrombocytopenia (97.6%) and electrolyte abnormalities, most commonly hypokalemia (57.1%). Rarer adverse events included bradycardia (4.8%), hypotension (4.8%), hypertension (2.4%), and apnea (2.4%).

Conclusions: Neonatal ETs are still most commonly performed for hyperbilirubinemia, but HDFN is only the etiology in a small fraction of these cases. GALD/NH was the second most common indication seen in this study. While most procedures are well-tolerated, thrombocytopenia and hypokalemia are frequent adverse events.