Morbidity and Mortality Associated with Exchange Transfusion

The frequency and effects of exchange transfusion in a large number of prospectively studied neonates in the National Institute of Child Health and Human Development (NICHD) phototherapy study of 1974 to 1976, who were randomly assigned to receive phototherapy or not, are reported here.18 Previously published studies14,52,78,102 on the morbidity and mortality rates of exchange transfusion are based upon experience accumulated prior to 1970. MATERIALS AND METHODS A total of 190 patients received 331 exchange transfusions. Data concerning each exchange transfusion were collected and analyzed by the NICHD Phototherapy Study Statistical Center. Statistical comparisons were done by X2 and Student's t test when appropriate. A narrative description of events surrounding an exchange transfusion was obtained if morbidity requiring clarification was reported, such as a cyanotic episode associated with the procedure. Additional information was obtained from the postmortem report on every infant who received an exchange transfusion and died, and for whom an autopsy was performed. All centers used fresh donor blood anticoagulated with a solution of citrate, phosphate, and dextrose. Patients in two centers routinely received small doses of calcium gluconate periodically during the procedure. Calcium gluconate was given to the others only if tachycardia or unusual irritability developed. All procedures were performed using modifications of the technique described by Allen and Diamond.2 Aliquots of blood used in the exchange ranged from 5 to 20 mL; the smaller aliquots were used in the low-birth-weight patients. Indications for exchange transfusion by birth weight, serum bilirubin concentration, and other clinical indices of risk were contained in the study protocol.