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G431(P) Neonatal exchange blood transfusion – a 13 month survey in UK and Ireland
  1. R Gottstein1,2,
  2. J Rennie3,
  3. S Hannam4,
  4. A Ryan5,6,
  5. H New7,8
  1. 1Newborn Intensive Care Unit, Central Manchester University Hospitals Foundation Trust, Manchester, UK
  2. 2Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
  3. 3Newborn Intensive Care Unit, University College London Hospitals, London, UK
  4. 4Neonatology, Great Ormond St Hospital for Children, London, UK
  5. 5Newborn Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
  6. 6Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
  7. 7NHS Blood and Transplant, London, UK
  8. 8Department of Haematology, Imperial College Healthcare NHS Trust, London, UK

Abstract

Aims to ascertain the incidence, outcome of babies undergoing neonatal exchange blood transfusions (EBT) in UK and Ireland during a 13month period between 1st October 2014 and 31st October 2015.

Methods Data capture uses standard British Paediatric Surveillance Unit methodology; details of the study protocol are available at www.rcpch.ac.uk/bpsu/ebt">http://www.rcpch.ac.uk/bpsu/ebt">www.rcpch.ac.uk/bpsu/ebt

Results In 13months of reporting, 157 cases were reported. 23 were duplicate reports and 5 were errors. Data is still being reported for 36 cases. Data collection is complete in 93 babies who underwent 115 EBTs (range 1–5). Gestational age range 28–41weeks; median 36(IQR: 34, 36) and birth-weight 617g–4440g; median 2580g (IQR: 2220, 3070g). EBT were performed in NICUs in 68%, SCBUs in 27.5% and PICU/Paediatric HDU 4.5%.

Indications: Hyperbilirubinaemia was the most frequent indication for EBT, occurring in a total of 80 babies (86%), anaemia 14(15%) and hydrops 2(2%). Some babies had more than one indication (Figure 1).

Underlying diagnosis: Rh-38(43%), ABO incompatibility-23(26%), multiple red cell antibodies-7(8%), hereditary spherocytosis-3(3%), G6PD deficiency-1(1%), dehydration-1(1%), unknown-8(9%) and other-8(9%).

Time to obtaining suitable red cells: range 22mins to 17½ hrs; median 4 hrs35mins (IQR: 2 hrs 40 mins, 7 hrs 04 mins).

Morbidity:

Of 16 babies who had MRI brain scans, 6 were normal, 8 abnormal and 2 poor quality/not recorded (Table 1).

Abstract G431(P) Table 1

Mortality: There were four deaths, three occurring in severely ill infants (hemophagocytic lymphohistiocytosis, leukaemia, congenital Cytomegalovirus) and one death from splenic rupture.

Conclusion Although the commonest indication for EBT remains hyperbilirubinaemia secondary to haemolysis, babies are also undergoing EBT for other reasons (dehydration, CMV or HLH associated hyperbilirubinaemia, Figure 3). Importantly, in a high proportion of infants 9 (10%) no underlying diagnosis of hyperbilirubinaemia was made. Of 93 infants with complete data, 60 (65%) were preterm and four were extremely low birth weight infants. A significant number of babies (19%) required more than one EBT. Some of the morbidity reflects the severity of clinical situations in which EBTs are undertaken. One death (splenic rupture) occurred during the procedure.

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