Single versus double volume exchange transfusion in jaundiced newborn infants

Extremely high levels of bilirubin (severe jaundice) can lead to brain damage. Severe jaundice in newborns can occur as a result of a variety of causes including rhesus hemolytic disease, ABO incompatibility, atypical antibodies etc. Removal of blood from the affected infant and replacing with fresh blood from the blood bank (exchange transfusion) is used as a treatment for severe jaundice in newborn infants. The affected infant's blood is removed in small portions and equal volume of blood is replaced during exchange transfusion. Traditionally twice the blood volume of baby is removed and the replaced with fresh blood. Exchange transfusion has been shown to reduce brain damage in severely jaundiced babies; however, exchange transfusion is associated with serious adverse events including death. It is likely that the complications of exchange transfusion would increase with amount of blood exchanged. This review was undertaken to examine if single volume (removal of blood equivalent to the blood volume of the baby) is as effective as double volume (removal of twice blood volume of the baby) in reducing the brain damage and bilirubin levels in newborn infants with severe jaundice. Only one randomised trial fulfilled the criteria for inclusion in the analysis. This study compared single and double volume exchange transfusion in jaundice due to ABO hemolytic jaundice. The study found no significant difference in bilirubin levels following exchange. This study did not look at any long term neurodevelopmental outcome (brain damage). Based on the available data, there is insufficient evidence to support or refute the use of single volume exchange transfusion as opposed to double volume exchange transfusion in jaundiced newborns.