Exchange transfusion is performed if intensive phototherapy (what is phototherapy click here)  has failed to reduce bilirubin levels to a safe range and if the risk of kernicterus exceeds the risk of the procedure or the infant has signs of kernicterus. Potential complications from exchange transfusion are not trivial and include acidosis, electrolyte abnormalities, hypoglycemia, thrombocytopenia, volume overload, arrhythmias, NEC, infection, graft vs host disease, and death. This widely accepted treatment is repeated if necessary to keep indirect bilirubin levels in a safe range.

•Various factors may affect the decision to perform an exchange transfusion in an individual patient. The appearance of clinical signs suggesting kernicterus is an indication for exchange transfusion at any level of serum bilirubin. A healthy full-term infant with physiologic or breast milk jaundice may tolerate a concentration slightly higher than 25 mg/dL with no apparent ill effect, whereas kernicterus may develop in a sick premature infant at a significantly lower level. A level approaching that considered critical for the individual infant may be an indication for exchange transfusion during the 1st or second day of life when a further rise is anticipated, but not on the 4th day in term infants or on the 7th day in premature infants, when an imminent fall may be anticipated as the hepatic conjugating mechanism becomes more effective
Pharmacological Therapy Should be continued concomitantly.

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