Prevalence of exchange blood transfusion in severe hyperbilirubinaemia and outcome at the University of Maiduguri Teaching Hospital Maiduguri, Northeastern Nigeria

Abstract

Background: Exchange blood transfusion (EBT) is carried out for the treatment of conditions presenting with severe hyperbilirubinaemia and anaemia, such as ABO incompatibility, sepsis, prematurity and birth trauma among others. While it is fast being abandoned as treatment modality for severe neonatal jaundice in the resource rich countries, it is still a backbone of treatment for severe neonatal jaundice in resource limited settings. Since such a study has not been done in this centre before now, we decided to study the positive effects of exchange blood transfusion in Maiduguri, North-Eastern Nigeria.
Objective: To determine the prevalence, indications and outcome of exchange blood transfusion at the Special Care Baby Unit of the University of Maiduguri Teaching Hospital, Maiduguri.
Methods: This is a retrospective study which examined the records of babies admitted into the SCBU between 1st January to December 31st 2014 with the aim of determining the prevalence of EBT at the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri.The indications for EBT and mortality among babies who had EBT are also highlighted.
Results: A total of 639 babies with gestational ages between 30weeks to 42weeks were admitted into the Special Care Baby Unit (SCBU) over the period of 12 months. Of this number, 64 (10%) had neonatal jaundice. Thirty (46.9%) of the 64 neonates with NNJ had EBT, their pre- EBT, serum bilirubin (SB) level ranged from 15mg/dL to 28.5mg/ dL with mean of 21.5 ±13.0mg/dL, while the post EBT SB ranged from 3.0mg/dL to 11.3mg/dl with mean of 7.2±8.3mg/dL. The aetiological risk factors of severe hyperbilirubinaemia in the newborns who had EBT include ABO incompatibility 17(56.7%), sepsis 12 (40.0%), prematurity 10(33.3%). Out of 30 neonates had EBT, 25 (83.3%) survived and were discharged, 5(16.7%) died and 3 with bilirubin encephalopathy,1with severe perinatal asphyxia with hypoxic ischaemic encephalopathy stage II while the fifth death was a preterm extreme low birth weight.
Conclusion: In our setting, the prevalence of exchange blood transfusion is high and this is because a large number of our patients had severe NNJ at presentation, some with bilirubin encephalopathy. Exchange blood transfusion remains one of the most reliable and effective treatment modality to prevent bilirubin encephalopathy especially in settings where babies are brought late to health facility. Effort at health education of the population at risk, especially pregnant women on early recognition and referral to appropriate health facility for prompt treatment to prevent severe NNJ and bilirubin encephalopathy is highlighted.