Exchange transfusion for severe jaundice: Time is brain

Abstract

Background

Neonatal hyperbilirubinemia is a common clinical problem and is usually managed successfully with phototherapy. However, severe hyperbilirubinemia approaching or exceeding exchange transfusion thresholds, particularly when associated with neurological dysfunction, constitutes a neonatal emergency. Although exchange transfusion has become less frequent in many settings, it remains a critical rescue intervention in selected infants. Current American Academy of Pediatrics (AAP) recommendations emphasize that decisions regarding exchange transfusion should be based on gestation- and age-specific bilirubin thresholds integrated with clinical neurological assessment. We report a late preterm infant with very high bilirubin levels and early neurological signs who required urgent double-volume exchange transfusion, underscoring the importance of timely escalation of care in an appropriately equipped neonatal intensive care unit (NICU).