Exaggerated Physiological Jaundice and Exchange Transfusion in Neonates

Neonatal jaundice, particularly unconjugated hyperbilirubinemia, is a common condition that can lead to bilirubin-induced neurologic dysfunction (BIND) if severe. Physiological jaundice is typically benign, but exaggerated forms may necessitate interventions like phototherapy or exchange transfusion. This study aimed to determine the incidence and contributing factors of exaggerated physiological jaundice requiring exchange transfusion in neonates.

This retrospective case series analyzed medical records from January 2020 to January 2023 at Northwest General Hospital, Peshawar. Neonates with physiological hyperbilirubinemia (serum bilirubin ≥17 mg/dL) who underwent exchange transfusion were included. Data on demographics, clinical signs, feeding, and laboratory findings were extracted using a structured tool and analyzed with IBM SPSS Statistics for Windows, version 25.

Out of 136 neonates with exaggerated physiological jaundice, 20 (14.7%) required exchange transfusion. The mean age at presentation was 5.2 ± 1.9 days. Males constituted 61.9%, and 81.0% were full-term. Exclusive breastfeeding was reported in 76.2% of cases. The mean total serum bilirubin at admission was 26.52 ± 7.7 mg/dL, reducing to 14.16 ± 2.6 mg/dL post-transfusion. Exclusive breastfeeding (76.2%), low birth weight (23.8%), and prematurity (14.3%) were identified as leading factors.

A significant proportion (14.7%) of neonates with exaggerated physiological jaundice required exchange transfusion. Exclusive breastfeeding, low birth weight, and prematurity were common contributing factors. These findings highlight the importance of early identification, close monitoring, and targeted management to reduce the need for aggressive interventions in this vulnerable population.