Frequency of Causes of Unconjugated Hyperbilirubinemia Leading to Exchange Transfusion

Objectives: To determine the frequency of various causes of neonatal hyperbilirubinemia requiring exchange transfusion. Methodology: This descriptive cross-sectional study was conducted from November 20, 2022, to May 19, 2023. in the Department of Pediatric Medicine at the Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of 110 neonates of either gender, requiring exchange transfusion due to unconjugated hyperbilirubinemia, were included. Inclusion criteria were neonates diagnosed with unconjugated hyperbilirubinemia based on clinical evaluation and laboratory findings. Neonates who had previously received phototherapy or had conjugated hyperbilirubinemia were excluded. Informed consent was obtained from parents or guardians prior to enrollment. Comprehensive demographic and clinical data, including birth weight, gestational age, gender, and mode of delivery, were collected. The principal investigator assessed each neonate to identify the underlying cause of hyperbilirubinemia, which included isoimmune hemolysis, ABO incompatibility, Rh incompatibility, and other possible etiologies. Assessment involved clinical examination, review of laboratory results, and interpretation of blood group compatibility between mother and newborn. All findings were documented on a structured proforma specifically designed for the study. Results: The mean gestational age was 37.59 ± 1.74 weeks (Table I). Of the 110 neonates, 73 (66.36%) were male and 37 (33.64%) were female, with a male-to-female ratio of 1.9:1. Among the identified causes of hyperbilirubinemia, Rh incompatibility was the most frequent, observed in 55 (55.0%) cases, followed by ABO incompatibility in 45 (40.90%) cases. Isoimmune hemolysis and other causes accounted for 5 (4.55%) cases each. Conclusion: Rh incompatibility was found to be the most common cause of neonatal jaundice requiring exchange transfusion, followed by ABO incompatibility and isoimmune hemolysis.