Adverse Events Of Neonatal Hyperbilirubinemia With Exchange Transfusion Therapy

Objective: To analyze the etiological composition of neonatal hyperbilirubinemia treated with exchange transfusion therapy and summarize the adverse events of exchange transfusion therapy,investigate the related risk factors of adverse events,and provide safety reference for clinical application of exchange transfusion therapy.Materials and methods: This study included 275 neonates treated with exchange transfusion therapy from January 2013 to August 2020,and suffered any adverse effects as observation group,and without adverse events as control group.The two groups were compared in general conditions,laboratory indexes,etiology,antibiotics used 48 hours before and after exchange transfusion,the mother’s age,maternal diseases during pregnancy,and special medication during pregnancy,etc.The conditional logistic regression model was used to explore the related risk factors of exchange transfusion therapy.Results:1.275 cases were included in this study,169 cases were in the control group,106 cases were in the observation group.Etiological analysis showed that hemorrhagic disease was the most common cause(151 cases,54.91%),of which intracranial hemorrhage ranked the first(149 cases,54.18%),followed by hemolytic disease of newborn(119 cases,43.27%),among which ABO blood group incompatibility hemolysis was the most common(97 cases,35.27%).53 cases(19.27%)lost more than 10% of body weight,41 cases(14.91%)suffered from birth injuries,38 cases(13.82%)had unknown causes.122 cases(44.36%)were combined with at least two causes.2.134 adverse events occurred,among which thrombocytopenia was the most common(69 cases),the second was hypocalcemia(33 cases),and the other adverse events were hypokalemia(16 cases),convulsions(7 cases),apnea(4 cases),respiratory distress(2 cases),neonatal necrotizing enterocolitis(1 case),purulent appendicitis with perforation(1 case),heart functional insufficiency(1 case).25 cases were combined with at least two adverse events.3.There was a statistically significant difference between the two groups of the age of exchange therapy,the platelet count before exchange therapy,antibiotics within 48 hours before and after exchange therapy and combined with birth injury(P<0.05).The results of conditional logistic regression analysis showed that the application of antibiotics within 48 hours before and after exchange transfusion was a protective factor for adverse events(OR=0.484,95%CI 0.288-0.815),and combined with birth injury was an independent risk factor for adverse events after exchange transfusion(OR= 2.367,95%CI 1.085-5.164).Conclusion:1.In neonates with hyperbilirubinemia treated with exchange transfusion therapy,hemorrhagic diseases accounted for the largest proportion of the causes,followed by hemolytic disease,body-weight loss more than 10%,birth injuries and unknown causes.2.Thrombocytopenia was the most common adverse reaction of blood exchange therapy,followed by hypocalcemia,and severe adverse reactions were rare.3.The use of antibiotics within 48 hours before and after exchange therapy is a protective factor for adverse events,and combined with birth injury is an independent risk factor.