Role of exchange transfusion in the treatment of neonatal septicemia

ABSTRACT

This study included 30 neonates [20 males and 10 females] with advanced neonatal sepsis whose gestational age ranged between 30-42 weeks [mean 35.16 +/- 0.12 weeks]. All the cases were subjected to full history taking, thorough clinical examination and investigations which included complete blood picture, C reactive protein and blood culture. All the cases underwent either a single or double volume exchange transfusion with fresh whole blood. The phagocytic power was estimated twice before and after exchange transfusion. All the cases were thrombocytopenic and had variable total leucocytic counts. Mortality rate was significantly increased in those neonates with leucopenia. C reactive protein was positive in 83.3% of cases. Blood culture was positive in all cases, Klebsiella was the commonest organism isolated [90% of cases]. Both phagocytic index and lytic index [tests for phagocytic power] increased significantly after exchange transfusion. The overall mortality was 53.3% in spite of the antimicrobial treatment and the exchange transfusion and it was highest among prematures less than 34 weeks. There was clinical improvement in 66.6% of cases after exchange complete blood picture revealed improvement after the exchange especially for the percent stab cells. So, the judicious use of exchange transfusion is recommended especially in neonates with significant bleeding tendency or significant neutropenia.AUTM