Comparison of efficacy and safety of exchange transfusion through different catheterizations: Femoral vein versus umbilical vein versus umbilical artery/vein.

OBJECTIVE

To compare the efficacy and safety of exchange transfusion (ET) via three different catheterization methods: femoral vein (FV); umbilical vein (UV); and umbilical artery/vein (UA/V).

DESIGN

A retrospective cohort of neonates who underwent ET for hyperbilirubinemia between 1996 and 2007 was surveyed. Subjects with gestational age < 33 wks were excluded.

SETTING

Neonatal intensive care units in a tertiary referral hospital.

PATIENTS

A total of 109 neonates with 128 ET procedures (33 via FV, 35 via UV, and 60 via UA/V routes) were analyzed.

MEASUREMENTS AND MAIN RESULTS

There was no significant difference in the decline of total serum bilirubin between each group. When compared with the UA/V group, the transfusion rate was slower in the FV and UV groups (p < .001). Adverse events with clinical significance were more common in ET via the UA/V route than ET via the FV and UV routes (p < .05; odds ratio, 2.4; 95% confidence interval, 1.2-5.0). Neonates with ET via the UA/V route tended to have more asymptomatic laboratory aberrances (p < .01; odds ratio, 2.5; 95% confidence interval, 1.3-4.6). There were no significant differences in the transfusion rate (p = .498) and adverse events (p = .822) between the FV and UV groups.

CONCLUSIONS

ET through the FV route is an effective and secure method for the treatment of neonatal hyperbilirubinemia when the UV route is unavailable. Physicians should be cautious when using UA/V catheterization for ET.