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Clinical Studies on Neonatal Jaundice and Exchange Transfusion.

Journal of the Korean Pediatric Society 1986;29(5):535-542.
Published online May 31, 1986.
Clinical Studies on Neonatal Jaundice and Exchange Transfusion.
Byoung Hun Kim, Soo Yup Lee, Jeh Hoon Shin, Kyu Hwan Lee, Soo Jee Moon, Chong Moo Park
Department of Pediatrics, College of Medicine,Hanyang University, Seoul,Korea
신생아 중증 황달과 교환수혈에 관한 연구
김병훈, 이수엽, 신재훈, 이규환, 문수지, 박종무
한양대학교 의과대학 소아과학교실
Abstract
Jaundice occurs rather frequently in neonatal period, and yet the irreversible complication, kernicterus, may occur in severe cases with pathologic jaundice, from which the patients are at high risk for mental retardation, cerebral palsy, and even death. To prevent this complication, aggressive measures have been used for the neonatal janudice, such as phototherapy and exchange transfusion. Exchange transfusion has been used for many years as the most reliable and fast-working method to reduce the bilirubin level and, thereby, to reduce the risk for kernicterus. 411 infants who underwent exchange transfusion were selected for this study among total 7,359 cases of neonatal jaundice, hospitalized at Hanyang University Hospital during the period of 13 years from July, 1972 to June, 1985. These 411 newborns were analysed clinicially and the following results were obtained: 1) Among 7,359 cases of neonatal [jaundice, the exchange transfusion was performed:on 411 cases (5.6%). 2) The major causes of jaundice among ^the total group of jaundiced infants were ABO incompatibility(38.8%), sepsis(29.9%), prematurity(3.6%) Rh incompatibility(1.5%), and unknown causes (20.7%) 3) Analysing the exchanged 411 cases, ABO incompatibility accounted for 43.9% of the total exchanged group; Rh [incompatibility 30. 0%, sepsis 27.3% unknown causes 21.3%, other known causes 18.8%; and two known causes combined 17.6%. Premature infants accounted for 3.0% among the total exchanged. 4) As to the type of blood incompatibility, O-A type incompatibility accounted for 20.4 %> and O-B type incompatibility for 15.1%. 5) The onset of jaundice was most frequently within 48 hours (58.6%) after birth. 6) The mean bilirubin levels before and after the exchange transfusion were 28.5 mg% and 13.6 mg% respectively, and the reduction rate of the bilirubin level by one exchange transfusion was 52.3%. 7) 14.1% of the cases required repeated exchange transfusion. 8) 6 cases (1.5%) out of the 411 exchanged cases developed kernicterus, and only one case succumbed subsequently after exchange transfusion . 9) In conclusion, kernicterus as the irreversible complication should be prevented by early diagnosis and appropriate treatment of severe neonatal jaundice. .In Korea, ABO incompatibility accounts for the most cases of severe neonatal jaundice and therefore. workup should be initiated early to avoid the grave complication by appropriate measures, especially in the cases of ABO incompatibility.
Key Words: Neonatal jaundice, Exchange transfusion.


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