Exchange transfusions in neonatal sepsis

Between October, 1987 and October, 1988, 53 neonates with severe or unresponsive sepsis were subjected to therapeutic exchange transfusions (ET) using 170 ml/kg of citrated blood less than 24 hours old. The procedure was repeated up to a maximum of 4 times. The success of therapy was adjudged by resolution of sclerema and/or improvement in clinical features. There were 32 low birth-weight (LBW) and 21 non-LBW infants and 51/53 subjects had sclerema. The mean time for recovery following ET was 19.6 +/- 12.4 h (range: 1-48 h). The overall survival was 77.4% and the survival rates for LBW and non-LBW infants were 73.6 and 68.2%, respectively, however, the difference was not statistically significant. No significant or fatal complications occurred during ET. The effects of other associated problems on outcome studied by multiple regression analysis showed that neurologic problems were associated with a poor chance for survival despite ET. Exchange transfusion may thus be an effective and safe therapeutic modality for severe neonatal sepsis.