ADVERSE EVENTS ASSOCIATED WITH EXCHANGE-TRANSFUSION IN HEALTHY AND ILL NEWBORNS

Objective. To determine the incidence of adverse events attributable t o exchange transfusion during the past 15 years and compare the incide nce of severe complications between healthy and ill infants. Design. M edical records for the past 15 years from two teaching hospitals with neonatal intensive care units were reviewed. Those newborns who underw ent exchange transfusions were classified as healthy or ill. Adverse e vents were analyzed to determine whether they were attributable to the procedure. Results. Of the 106 patients who underwent exchange transf usion, 81 were healthy and had no medical problems other than jaundice . The remaining 25 patients were classified as ill and had medical pro blems ranging from mild to severe. At least 2 (2%) of the 106 patients died of complications probably attributable to exchange transfusion. None of the 81 healthy infants died, but 1 had severe necrotizing ente rocolitis requiring surgery. Of the 25 ill infants, at least 3 (12%) e xperienced severe complications (including 2 deaths) probably attribut able to exchange transfusion. Serious complications from the most comm on adverse events, hypocalcemia and thrombocytopenia, were limited to the group of infants already ill with other medical problems. Conclusi ons. Because of the significantly greater rate of severe complications in ill infants, exchange transfusion should be delayed until the risk of bilirubin encephalopathy is as high as the risks of severe complic ations from the procedure itself (12%). These results do not support r ecommendations to use lower exchange levels in ill infants compared wi th healthy infants.