• While there are multiple causes of hyperbilirubinemia,
severe disease is most commonly the result of isoimmune hemolytic
disease of the newborn secondary to Rh, ABO, or other antigen incompatibility.
• Perhaps the most difficult aspect of this procedure is determining
when the level of hyperbilirubinemia warrants its use.
• A clinical practice guideline was recently published by
the American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.
• Recommended total serum bilirubin (TSB) levels for exchange transfusion are provided in this document and are based largely on keeping TSB levels below those at which kernicterus has been reported.
• Exchange transfusion is performed infrequently due to improved
prenatal prevention and management of hemolytic disease of the newborn.