Table 35-39 lists potential complications of exchange transfusion and the overall risks of exchange transfusion were reviewed by Ip and associates (139). Reporting the morbidity and mortality associated with exchange transfusion is difficult because both are significantly dependent on the clinical state of the infant before the exchange transfusion. Morbidity and mortality are much lower in term infants with idiopathic hyperbilirubinemia than in sick preterm infants who might be critically ill at the time of the exchange transfusion. In addition, definitions of exchange transfusion-related mortality are not consistent between studies and it is difficult to determine from the literature whether the exchange transfusion procedure itself, or other morbidities were responsible for the deaths of these infants. In addition, many of the published studies refer to infants born before 1970 and there are few U.S. studies of infants born after 1990. Contemporary information
on the mortality of exchange transfusions is difficult to obtain, given the infrequency of the procedure. In full-term and near-term infants who are relatively well, the risk of death is low (540,541,542). The overall mortality is approximately 3 in 1,000 procedures (540,541,543). In the NICHD cooperative phototherapy study (540), morbidity (apnea, bradycardia, cyanosis, vasospasm, thrombosis) was observed in 22 of 328 (6.7%) of exchange transfusions performed. Of the 22 adverse events, however, 6 were mild episodes of bradycardia associated with calcium infusion. Excluding those infants, as well as two who experienced transient arterial spasms, the incidence of significant morbidity associated with the procedure was 5%.