Abstract 1230 Poster Session IV, Tuesday, 5/4 (poster 356)

Phototherapy has had a dramatic impact on the number of exchange transfusions (ET) performed for hyperbilirubinemia, and the use of Rh-immune globulin has drastically reduced the number of newborns with erythroblastosis fetalis. In addition, current guidelines for ET both in the non-hemolyzing term newborn and the LBW infant are less stringent. We reviewed the number of ET's performed in our hospital over a 10 year period, from January 1998 through December 1997. During this time there were 55, 128 live births, 6,779 admissions to our Special Care Nursery and 2,985 admissions to our NICU. Eight exchange transfusions were performed on inborn infants. The cause of hyperbilirubinemia was hemolytic disease in 5 infants (4 Rh, 1 anti-E), breast-feeding associated jaundice in 2, and idiopathic hyperbilirubinemia in one profoundly asphyxiated 34 week gestation infant. None of the infants with hemolytic disease received IVIG. The peak bilirubin levels ranged from 12.8-28.9 mg/dL. There were 1,213 infants with birth weights <1500 gm and none of them received an exchanged transfusion. During the same period, 8 ET's were performed on outborn infants (6 ABO incompatibility, 1 associated with breast-feeding and 1 idiopathic). Peak bilirubin levels ranged from 22.0-33.6 mg/dL.

In a hospital delivering more than 5,000 newborns annually, we averaged less than one exchange transfusion per year on the inborn population. With this degree of exposure, pediatric residents can no longer be trained to perform exchange transfusions. The use of intensive phototherapy, the development of new phototherapy techniques such as light emitting diodes, and pharmacologic interventions such as IVIG and heme oxygenase inhibitors, will likely reduce these numbers even further. This will make it difficult even for neonatal fellows to receive appropriate training in this technique. With decreasing experience, the likelihood of complications with each procedure will increase.