Insights from a 23-year analysis published in Transfusion Clinique et Biologique revealed that neonatal exchange transfusion (ET) use in Serbia has decreased for babies with hemolytic disease of the fetus and newborn (HDFN). The study examined long-term trends in ET rates, clinical indications and outcomes within a transitioning healthcare system.
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Researchers reviewed every ET performed between 2001 and 2023, capturing all neonates who required the procedure for severe hyperbilirubinemia or hemolytic disease. The analysis focused on how often ET was needed, the conditions that prompted it and how patients responded after treatment.
Over the study period, 243 ET procedures were performed among 206 newborns out of more than 145,000 deliveries. ET use dropped from 6.4 per 1000 deliveries in 2001 to zero in both 2011 and 2023, reflecting improvements in phototherapy access and prenatal care. Most infants required only one procedure, underscoring the effectiveness of current treatment protocols.
HDFN accounted for two-thirds of ETs. Anti-D alloimmunization was the leading cause, responsible for 65.9% of sensitized cases. Among newborns without alloimmunization, severe anemia, infections, and other conditions contributed to the need for ET. Cesarean delivery was common among infants who required treatment, and most procedures involved double-volume exchange. No ET-related deaths occurred, and reported complications were temporary.
“The persistent need for exchange transfusion, largely due to anti-D alloimmunization, reflects challenges common in resource-limited settings,” the authors wrote, noting the importance of strengthening preventive strategies.
In their discussion, the researchers emphasized that the continued role of anti-D alloimmunization highlights gaps in prophylaxis programs, especially in areas with limited prenatal screening. They added that improving access to bilirubin monitoring and ensuring consistent administration of Rh immunoglobulin could further reduce preventable cases. The authors concluded that the Serbian experience offers insight for healthcare systems undergoing similar transitions worldwide.
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