Impact of National Clinical Practice Guidelines on Exchange Transfusion for Severe Neonatal Hyperbilirubinemia in Singapore

Abstract

Aims: To review the incidence of double volume exchange transfusion for severe neonatal hyperbilirubinemia in infants ≥35 weeks’ gestational age before and after implementation of National Clinical Practice Guidelines (NCPGNJ), analyze etiologies for severe hyperbilirubinemia, readmission rates for phototherapy and neurodevelopmental outcomes up to 2 years. Study Design:  Retrospective study Place and Duration of Study: KK Women’s and Children’s Hospital, Singapore, between January 2016 and December 2021. Methodology: National Clinical Practice Guidelines on Evaluation and Management of Neonatal Jaundice (NCPGNJ) was implemented in January 2019. We retrospectively reviewed the medical records of neonates in our center who underwent double volume exchange transfusion for severe neonatal hyperbilirubinemia before and after implementation of the national clinical practice guidelines. Results: Overall, 56 infants underwent double volume exchange transfusion for severe hyperbilirubinemia during the study period. There was a decline in the incidence of exchange transfusion from 107 per 100 000 live births in epoch 1 (2016-2018) to 61 per 100 000 live births in epoch 2 (2019-2021). There was a steady decline in overall phototherapy rates (p=0.06), readmission rates for phototherapy (p=0.04) and number of neonates needing exchange transfusion (p=0.25). ABO-hemolytic disease of the newborn was the most common etiology. One infant had delayed presentation of severe hyperbilirubinemia and eventually developed cerebral palsy. The rest of the infants had normal neurodevelopmental and audiological assessments at follow-up. Conclusion: The evidence-based National Clinical Practice Guidelines (NCPGNJ) has reduced the incidence of exchange transfusion. It provides a unified framework for all healthcare professionals who manage neonates with hyperbilirubinemia in different healthcare settings.