Impact of Exchange Transfusion in Neonatal Hyperbilirubinemia: A Contrast Between Non-blood Group and Blood Group Antibody-induced​

Impact of Exchange Transfusion in Neonatal Hyperbilirubinemia: A Contrast Between Non-blood Group and Blood Group Antibody-induced​ | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Exchange Transfusion in Neonatal Hyperbilirubinemia: A Contrast Between Non-blood Group and Blood Group Antibody-induced​ Qingting Chen, Xiufeng Xu, Kunhai Wu, Jianyuan Liao, Lufei Chen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7044497/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose: Exchange transfusion (ET) is the most rapid and effective intervention for neonatal hyperbilirubinemia. This study examines the impact of blood group antibodies on the efficacy of ET in treating severe hyperbilirubinemia, aiming to inform clinical strategies. Patients and methods: Between March 2011 and July 2024, 273 hyperbilirubinemic newborns underwent ET. They were divided into blood group antibody negative (BGAbN) and positive (BGAbP) groups. Serum total bilirubin (STB), serum indirect bilirubin (SIB), and platelet count (PLT) were assessed before and after ET to compare its effectiveness between the groups. Results: Following ET, a significant decrease in STB, SIB, and PLT levels was noted in both groups (P.05). Gender-based analysis indicated no notable variations in STB, SIB, and PLT levels between the two ET groups in males (P>.05); nevertheless, females in the BGAbN group displayed significantly lower STB and SIB levels post-ET (P<.05). Conclusion: ET stands out as the most immediate and effective treatment for severe neonatal hyperbilirubinemia. The presence of blood group antibodies and neonatal gender impact the efficacy of ET. Blood group antibody Exchange transfusion Hyperbilirubinemia Neonate Figures Figure 1 Figure 2 Introduction Neonatal hyperbilirubinemia, marked by elevated bilirubin levels in the blood, is a prevalent clinical issue that can result in serious complications like kernicterus if not addressed. ET is widely acknowledged as a prompt and efficient approach for treating severe hyperbilirubinemia, especially in cases where conventional therapies prove inadequate [ 1 , 2 ]. The effectiveness of erythrocyte transfusion may be affected by various factors, such as the presence of blood group antibodies, which can influence compatibility and the success of the transfusion [ 3 , 4 ]. Blood group antibodies, particularly those targeting the ABO and Rh systems, have the potential to cause hemolytic reactions and elevate bilirubin levels [ 5 – 7 ]. Some studies have investigated the impact of maternal antibodies on hemolytic disease of the newborn, which can complicate the management of hyperbilirubinemia [ 12 , 13 ]. The interaction between these antibodies and donor blood during ET could potentially affect the outcome [ 8 ]. Additionally, recent findings suggest that gender may also influence the response to ET, with female neonates possibly exhibiting distinct bilirubin kinetics compared to their male counterparts [ 9 , 10 ].. Several studies have examined the effects of blood incompatibility during ET with differing outcomes [ 11 ]. Furthermore, research has explored the role of gender in bilirubin metabolism, with some studies suggesting that female neonates might be at a higher risk of severe hyperbilirubinemia [ 14 – 16 ]. Understanding the influence of blood group antibodies and gender on the efficacy of ET is essential for optimizing treatment approaches and enhancing clinical results. This study aimed to assess whether blood group antibodies and gender affect the efficacy of neonatal ET in severe hyperbilirubinemia.A significant gap exists in the literature regarding the comparative effectiveness of ET therapy for patients with BGAbN versus BGAbP individuals. Addressing this gap, our research focuses on investigating the impact of blood group antibody factors on the efficacy of ET, providing valuable insights to guide clinical practice. Material and methods Study design This study was conducted on all neonates who underwent ET for hyperbilirubinemia in the Sentinel hospital of Putian city. Inclusion criteria were as follows: a. New-borns admitted to the hospital due to hyperbilirubinemia and treated with ET, b. Meeting the eligibility standards for ET, and c. Children undergoing compatible exchange transfusion therapy. Exclusion criteriawere as follows: a. Children with hyperbilirubinemia who have not undergone exchange transfusion, b. Children with incompatible exchange transfusion, c. Children with incomplete data, and d. Children with other serious diseases. We divided neonates into BGAbN ET and BGAbP ET treatment groups; compared changes in STB, SIB, and PLT pre- and post-ET and analysed the clinical data of the neonates and infants. Study on the influence of blood group antibody factors on the effect of newborn compatible transfusion. The efficiency of ET is calculated by the formula: (Pre-ET value - Post-ET value) / Pre-ET value × 100%. Patients and equipments Between March 2011 to July 2024, a total of 273 newborns hospitalized for hyperbilirubinemia received ET treatment. They were divided into the BGAbN ET group (n = 148) and the BGAbP ET group (n = 125). Data on 280 neonatal cases of hyperbilirubinemia ET in the Department of Neonatology, a premier Tertiary Maternity and Children's Hospital of Fujian Province, from March 2011 to July 2024 were collected, of which 273 met the inclusion criteria. They were divided into BGAbN ET (n = 148) and BGAbP ET (n = 125) groups. The test instrument used for bilirubin was the Abbott al16200 (Abbott, Chicago, USA). The number of platelets was detected using the instrument Sysmex®XN-3000 (Sysmex Corporation, Kobe, Japan). The instrument used for blood type and neonatal haemolysis tests was the WADiana DG-57 (Diagnostic Grifols, Barcelona, Spain). Blood selection and dosage Newborns with ABO hemolysis were administered O-type RBCs and AB-type fresh frozen plasma. In Rh hemolysis cases, infants received ABO and Rh-compatible blood products. Blood was meticulously cross-matched, adhering to a standard volume of 160–180 mL/kg body weight for precise and safe transfusion. ET were executed via a peripheral arteriovenous double-lumen catheter, with the scalp vein for infusion and the radial artery for blood extraction. The ET volume was strictly maintained at 160–180 mL/kg body weight, ensuring a minimal volume discrepancy of 3–5 mL/kg between infused and withdrawn blood. The infusion rate was meticulously regulated at approximately 5 mL/kg per minute, with the procedure typically lasting 1.5 to 2 hours. To prevent hypocalcemia, a calibrated 1 mL of 10% calcium gluconate solution was administered for every 100 mL of blood exchanged. Statistical analysis All statistical analyses were performed using SPSS Statistics version 27.0 (Armonk, NY, USA). The measurement data are expressed as mean ± standard deviation (i.e.‾x ± s), using the paired sample t-test and independent sample t-test, chi-squared test for the analysis of normative comparisons. P-values less than 0.05 were considered statistically significant. Results A total of 273 newborns with severe hyperbilirubinemia with ET. Among the included cases, there were 164 males and 109 females; the gestational age was 33–41 weeks; the birth weight was 1.6–4.3 kg. The newborns were divided into BGAbN ET group with 148 cases and BGAbP ET group with 125 cases. (Fig. 1 ) Table 1 The analysis of STB, SIB and PLT pre- and post-ET STB SIB PLT Pre- ET 471.51 ± 93.14 438.89 ± 87.25 262.66 ± 98.80 Post-ET 256.26 ± 67.71 238.93 ± 64.72 93.17 ± 40.37 t 45.66 44.75 30.84 P < 0.001 < 0.001 < 0.001 STB: Serum Total Bilirubin (umol/L); SIB: Serum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion. The study population was categorized into two cohorts: a BGAbN ET group comprising 148 cases and a BGAbP ET group with 125 cases. Among the BGAbN ET group, there was a significant reduction in the levels of STB, SIB, and PLT, with STB declining from 504.45 ± 85.07 to 268.98 ± 72.19, SIB from 467.91 ± 79.41 to 249.71 ± 67.83, and PLT from 278.92 ± 104.33 to 96.86 ± 40.56. The BGAbP ET group exhibited a parallel trend, with STB levels dropping from 432.50 ± 87.29 to 241.20 ± 58.79, SIB from 406.72 ± 84.71 to 226.15 ± 58.57, and PLT from 243.40 ± 88.43 to 88.79 ± 39.86. The decreases observed in STB, SIB, and PLT for both groups were statistically significant (P < 0.001). (Table 2 ) Table 2 The analysis of STB, SIB and PLT pre- and post-ET in the BGAbN and BGAbP groups BGAbN (148) P BGAbP (125) P Pre-ET Post-ET Pre-ET Post-ET STB 504.45 ± 85.07 268.98 ± 72.19 < 0.001 432.50 ± 87.29 241.20 ± 58.79 < 0.001 SIB 467.91 ± 79.41 249.71 ± 67.83 < 0.001 406.72 ± 84.71 226.15 ± 58.57 < 0.001 PLT 278.92 ± 104.33 96.86 ± 40.56 < 0.001 243.40 ± 88.43 88.79 ± 39.86 < 0.001 STB: Serum Total Bilirubin (umol/L); SIB: Serum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion; BGAbN: Blood group antibody negative; BGAbP: Blood group antibody positive. A comparative study on ET efficiency between two groups revealed that the BGAbN group and BGAbP group exhibited ET efficiencies for STB, SIB, and PLT of 46.44 ± 12.37, 46.33 ± 13.41, 62.56 ± 15.24 and 43.54 ± 11.17, 43.70 ± 11.63, 60.75 ± 17.87, respectively. Notably, a statistically significant difference in the STB exchange efficiency was identified between the two group (P < 0.05). (Table 3 ) Table 3 The efficacy of ET in the STB, SIB and PLT among the BGAbN and BGAbP groups. Exchange Transfusion Efficiency (%) BGAbN (148) BGAbP (125) p STB 46.44 ± 12.37 43.54 ± 11.17 0.045 SIB 46.33 ± 13.41 43.70 ± 11.63 0.088 PLT 62.56 ± 15.24 60.75 ± 17.87 0.367 Serum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion; BGAbN: Blood group antibody negative; BGAbP: Blood group antibody positive. Upon a gender-stratified analysis within the BGAbN and BGAbP groups, it was observed that the BGAbN group included 98 males and 50 females, whereas the BGAbP group had 66 males and 59 females. The ET efficiencies for STB, SIB, and PLT among male participants in the BGAbN and BGAbP groups were 45.00 ± 12.01, 44.86 ± 13.41, 62.47 ± 15.41, and 43.80 ± 12.06, 43.82 ± 12.30, 61.44 ± 15.49, respectively. No statistically significant differences were noted between the two groups for these parameters (P > 0.05). In contrast, among female participants, the blood exchange efficiencies were 49.25 ± 12.70, 49.19 ± 13.08, 62.74 ± 15.07 for the BGAbN group and 43.25 ± 10.18, 43.57 ± 10.94, 59.98 ± 20.31 for the BGAbP group. Statistically significant differences were identified in the exchange efficiencies of STB and SIB between the two groups (P 0.05).((Table 4 and Fig. 2 a, 2 b) Table 4 The efficacy of ET in the STB, SIB and PLT among the BGAbN and BGAbP groups by gender Exchange Transfusion Efficiency (%) Male P Female P BGAbN (98) BGAbP (66) BGAbN (50) BGAbP (59) STB 45.00 ± 12.01 43.80 ± 12.06 0.529 49.25 ± 12.70 43.25 ± 10.18 0.007 SIB 44.86 ± 13.41 43.82 ± 12.30 0.615 49.19 ± 13.08 43.57 ± 10.94 0.016 PLT 62.47 ± 15.41 61.44 ± 15.49 0.676 62.74 ± 15.07 59.98 ± 20.31 0.428 STB: Serum Total Bilirubin (umol/L); SIB: Serum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion; BGAbN: Blood group antibody negative; BGAbP: Blood group antibody positive. Discussion Severe neonatal hyperbilirubinemia (SNH) is a significant cause of hospitalization and readmission within the first week of life globally [ 17 ]. It is a prevalent neonatal condition with various etiologies, including infections, enzymatic deficiencies, blood group incompatibilities, and idiopathic cases [ 18 , 19 ]. Kernicterus, an extreme form of jaundice, poses a severe threat to the nervous system and can result in adverse outcomes such as death or disability in critical cases [ 20 , 21 ]. ET is a crucial intervention for SNH, involving the strategic replacement of the infant's blood or blood components with donor blood or products [ 22 ]. This study critically examines the factors influencing the effectiveness of ET in managing severe neonatal hyperbilirubinemia, with a specific emphasis on the impact of blood group antibodies and gender. Following ET, a notable decrease in STB, SIB, and PLT levels was observed [ 23 ]. However, a detailed comparison between the BGAbN and BGAbP groups revealed a nuanced outcome, with the BGAbN group showing higher ET efficacy, as evidenced by a more significant reduction in STB levels. This outcome implies that the presence of blood group antibodies might hinder the optimal effectiveness of ET, a concept supported by prior research underscoring the role of ABO and Rh incompatibility in hemolysis and bilirubin production [ 24 , 25 ]. The gender-based analysis revealed notable findings. Female neonates in the BGAbP group exhibited a significant reduction in STB and SIB levels following ET, a trend not evident in male neonates or the BGAbN group. The specific mechanisms contributing to this gender disparity are currently unknown. Hormonal, immunological, or genetic influences may potentially impact the response to ET in female neonates. [ 26 – 28 ]. These findings point to potential gender-related differences in bilirubin metabolism that may affect the response to ET, a possibility that warrants further investigation. The findings of our study hold significant clinical implications for the treatment of severe hyperbilirubinemia in neonates. It is recommended to routinely screen for blood group antibodies in neonates with hyperbilirubinemia to identify individuals who may benefit from more intensive therapeutic measures. Additionally, when developing exchange transfusion protocols, the gender of the neonate should be taken into account, particularly for female neonates with blood group antibodies who may exhibit increased susceptibility to the negative consequences of hyperbilirubinemia. A significant limitation of this study is the skewed distribution of gestational age and birth weight among the participants, as stratification based on these variables was lacking for a more thorough analysis. Important factors such as gestational age, birth weight, and other clinical variables that may impact bilirubin levels and ET outcomes were not considered. Subsequent research endeavors should strive to overcome these limitations by conducting prospective studies with broader and more varied participant groups. These studies should delve into the biological mechanisms that underlie the noted gender variations in response to ET, potentially exploring genetic, hormonal, and metabolic influences. [ 29 – 31 ]. Conclusion In conclusion, our study provides important insights into the complex interplay between blood group antibodies, gender, and ET efficacy in the management of severe hyperbilirubinemia in neonates. The results emphasize the need for personalized clinical strategies that take into account individual patient characteristics to optimize therapeutic outcomes. By incorporating these findings into clinical practice, we can improve the care and prognosis of neonates with hyperbilirubinemia. Declarations Acknowledgments The Authors would like to thank the Blood Transfusion Department, Affiliated Hospital of Putian Uniwersity. Putian, Fujian, China for helping to perform part of this work. Author Contributions All authors contributed to the study conception and design. Material preparation and data collection were performed by Qingting Chen, date collation, analysis and statistics were performed by Kunhai wu, Huifang Huang. The first draft of the manuscript was written by Qingting Chen, Kunhai wu. Jianyuan Liao provided research ideas, Lifang Zhang revised the manuscript, oversaw and supervised the work by Xiufeng Xu, Lufe Cheni was responsible for coordination. All authors contributed to critical review and approved the final version of the manuscript. Funding The authors did not receive support from any organization for the submitted work. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Data availability The date used and analyzed during the current study are available from the corresponding author upon reasonable request. Consent to publish All images and data in the manuscript are original creations by us, and we possess full copyright for them. Conflict of interest The authors declare no competing interests. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki and was approval by the Institutional Research Ethics Committee of Affiliated Hospital of Putian Uniwersity, Ethical batch number: 2025175 . Informed consent was waived because the patients’ data were collected retrospectively. All patients’ data were anonymized before analysis. References Bhutani VK, Maisels MJ, Schutzman DL, et al. Identification of risk for neonatal haemolysis. ACTA PAEDIATR. 2018;107(8):1350–6. Management of hyperbilirubinemia. in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297–316. Okulu E, Erdeve Ö, Tuncer O, et al. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr. 2021;56(2):121–6. Gao XY, Huang H, Li LD. 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Trends in hospitalizations of newborns with hyperbilirubinemia and kernicterus in United States: an epidemiological study. J MATERN-FETAL NEO M. 2021;35(25):7701–6. Bhatt P, Parmar N, Ayensu M, et al. Trends and Resource Use for Kernicterus Hospitalizations in the United States. Hosp Pediatr. 2022;12(6):e185–90. Kim MS, Chung Y, Kim H, et al. Neonatal exchange transfusion: Experience in Korea. TRANSFUS APHER SCI. 2020;59(3):102730. Okulu E, Erdeve Ö, Tuncer O, et al. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr. 2021;56(2):121–6. Senterre T, Minon JM, Rigo J, [Neonatal. ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care]. ARCH Pediatr. 2011;18(3):279–82. Metcalf RA, Khan J, Andrews J, et al. Severe ABO Hemolytic Disease of the Newborn Requiring Exchange Transfusion. J PEDIAT HEMATOL ONC. 2019;41(8):632–4. Sarici SU, Saldir M. Genetic factors in neonatal hyperbilirubinemia and kernicterus. TURKISH J PEDIATR. 2007; 49 (3): 245-9. PMID: 17990575. Donneborg ML, Hansen BM, Vandborg PK, et al. Extreme neonatal hyperbilirubinemia and kernicterus spectrum disorder in Denmark during the years 2000–2015. J PERINATOL. 2020;40(2):194–202. Lai NM, Gerard JP, Ngim CF, et al. The Association between Serum Bilirubin and Kernicterus Spectrum Disorder: A Systematic Review and Meta-Analysis. NEONATOLOGY. 2021;118(6):654–64. Jain A, Malhotra S, Marwaha N, et al. Severe ABO hemolytic disease of fetus and newborn requiring blood exchange transfusion. ASIAN J TRANSF SCI. 2018;12(2):176–9. Dufour DR, Monoghan WP. ABO hemolytic disease of the newborn. A retrospective analysis of 254 cases. AM J CLIN PATHOL. 1980;73(3):369–73. Metcalf RA, Khan J, Andrews J, et al. Severe ABO Hemolytic Disease of the Newborn Requiring Exchange Transfusion. J PEDIAT HEMATOL ONC. 2019;41(8):632–4. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7044497","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485871181,"identity":"24d165c3-5de2-47b3-bc02-ecf99ffbec59","order_by":0,"name":"Qingting Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACfvnHBw58MJCQ42dvIFKLZENa4sMZFRbGkj0HiNRicCDH2JjnTEWiwYwEYl124IyZBG+bRIKB5OONNxhqbKIJ6mBsbCuTkGyTyDOXTiu2YDiWlttASAszM/M2CcM2iWLL2TlmEowNhwlrYWNjMJNIbJNI3HDzDJFaeHhYjA0OnAFqucFDpBYJCbbEhw0VEsBABvolgRi/2N9gPnD4j0EdMCoPb7zxocaGsBZkYCCRQIpyiBZSdYyCUTAKRsHIAAC5hD9R/ilSrwAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of Putian University","correspondingAuthor":true,"prefix":"","firstName":"Qingting","middleName":"","lastName":"Chen","suffix":""},{"id":485871182,"identity":"5899db6a-8576-4a97-bc37-e8ff2362247d","order_by":1,"name":"Xiufeng Xu","email":"","orcid":"","institution":"Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiufeng","middleName":"","lastName":"Xu","suffix":""},{"id":485871183,"identity":"b53f1ea9-44e1-4fae-93ac-211c243b2112","order_by":2,"name":"Kunhai Wu","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetric \u0026 Gynecology and Pediatrics: Fujian Provincial Maternity and Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kunhai","middleName":"","lastName":"Wu","suffix":""},{"id":485871184,"identity":"7d8b0769-3f68-4727-9010-1371078c18b8","order_by":3,"name":"Jianyuan Liao","email":"","orcid":"","institution":"Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"Jianyuan","middleName":"","lastName":"Liao","suffix":""},{"id":485871185,"identity":"918cb2ca-bce3-4bba-9706-6131dbba37dc","order_by":4,"name":"Lufei Chen","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetric \u0026 Gynecology and Pediatrics: Fujian Provincial Maternity and Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lufei","middleName":"","lastName":"Chen","suffix":""},{"id":485871186,"identity":"a7ddd430-04d9-4a96-9af1-103cc17793ba","order_by":5,"name":"Huifang Huang","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetric \u0026 Gynecology and Pediatrics: Fujian Provincial Maternity and Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huifang","middleName":"","lastName":"Huang","suffix":""},{"id":485871187,"identity":"ede26a7e-0a7a-4ac7-a85f-34188b477664","order_by":6,"name":"Lifang Zhang","email":"","orcid":"","institution":"Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","correspondingAuthor":false,"prefix":"","firstName":"Lifang","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-07-04 08:19:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7044497/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7044497/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87050667,"identity":"18d0a0f8-59b1-48fa-af0d-455a2e43d1b5","added_by":"auto","created_at":"2025-07-18 14:58:17","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":231144,"visible":true,"origin":"","legend":"\u003cp\u003eNeonatal jaundice ET screening flow diagram.\u003c/p\u003e\n\u003cp\u003eThe 273 cases of neonatal hyperbilirubinemia included in the study showed a significant decrease in STB from 471.51±93.14 to 256.26±67.71 after exchange transfusion; SIB decreased from 438.89±87.25 to 238.93±64.72; PLT decreased from 262.66±98.80 to 93.17±40.37. There was a significant decrease in STB, SIB, and PLT pre- and pro-ET (P\u0026lt;0.001). (Table 1)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7044497/v1/f1e44a57d4e9fb1934418661.jpeg"},{"id":87051991,"identity":"ee51167c-de5d-4970-8285-8be93752b110","added_by":"auto","created_at":"2025-07-18 15:06:17","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":227167,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea. \u003c/strong\u003eThe efficacy of ET for STB, SIB, and PLT among male participants in the BGAbN and BGAbP groups. \u003cstrong\u003eb. \u003c/strong\u003eThe efficacy of ET for STB, SIB, and PLT among female participants in the BGAbN and BGAbP groups.\u003c/p\u003e\n\u003cp\u003e1: BGAbN group 2: BGAbP group BGAbN: Blood group antibody negative; BGAbP: Blood group antibody positive m: male f: female\u003c/p\u003e\n\u003cp\u003eESTB: The efficacy of ET in the Serum Total Bilirubin; ESIB: The efficacy of ET in the Serum Indirect Bilirubin; EPLT: The efficacy of ET in the Platelet count.\u003c/p\u003e\n\u003cp\u003e*: indicates a statistically significant difference with a P-value less than 0.05.\u003c/p\u003e\n\u003cp\u003e**: indicates a statistically significant difference with a P-value less than 0.01.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7044497/v1/1b7f12cd01bb2569d3d2fde6.jpeg"},{"id":87052023,"identity":"d0293be3-04fd-4800-b8ae-76cc3baa6992","added_by":"auto","created_at":"2025-07-18 15:06:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1031074,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7044497/v1/f9485c57-f72c-4b1f-b4ab-5f9bcd92aa15.pdf"}],"financialInterests":"","formattedTitle":"Impact of Exchange Transfusion in Neonatal Hyperbilirubinemia: A Contrast Between Non-blood Group and Blood Group Antibody-induced​","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal hyperbilirubinemia, marked by elevated bilirubin levels in the blood, is a prevalent clinical issue that can result in serious complications like kernicterus if not addressed. ET is widely acknowledged as a prompt and efficient approach for treating severe hyperbilirubinemia, especially in cases where conventional therapies prove inadequate [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe effectiveness of erythrocyte transfusion may be affected by various factors, such as the presence of blood group antibodies, which can influence compatibility and the success of the transfusion [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Blood group antibodies, particularly those targeting the ABO and Rh systems, have the potential to cause hemolytic reactions and elevate bilirubin levels [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Some studies have investigated the impact of maternal antibodies on hemolytic disease of the newborn, which can complicate the management of hyperbilirubinemia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The interaction between these antibodies and donor blood during ET could potentially affect the outcome [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Additionally, recent findings suggest that gender may also influence the response to ET, with female neonates possibly exhibiting distinct bilirubin kinetics compared to their male counterparts [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]..\u003c/p\u003e\u003cp\u003eSeveral studies have examined the effects of blood incompatibility during ET with differing outcomes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, research has explored the role of gender in bilirubin metabolism, with some studies suggesting that female neonates might be at a higher risk of severe hyperbilirubinemia [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Understanding the influence of blood group antibodies and gender on the efficacy of ET is essential for optimizing treatment approaches and enhancing clinical results.\u003c/p\u003e\u003cp\u003eThis study aimed to assess whether blood group antibodies and gender affect the efficacy of neonatal ET in severe hyperbilirubinemia.A significant gap exists in the literature regarding the comparative effectiveness of ET therapy for patients with BGAbN versus BGAbP individuals. Addressing this gap, our research focuses on investigating the impact of blood group antibody factors on the efficacy of ET, providing valuable insights to guide clinical practice.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted on all neonates who underwent ET for hyperbilirubinemia in the Sentinel hospital of Putian city. Inclusion criteria were as follows: a. New-borns admitted to the hospital due to hyperbilirubinemia and treated with ET, b. Meeting the eligibility standards for ET, and c. Children undergoing compatible exchange transfusion therapy. Exclusion criteriawere as follows: a. Children with hyperbilirubinemia who have not undergone exchange transfusion, b. Children with incompatible exchange transfusion, c. Children with incomplete data, and d. Children with other serious diseases.\u003c/p\u003e\u003cp\u003eWe divided neonates into BGAbN ET and BGAbP ET treatment groups; compared changes in STB, SIB, and PLT pre- and post-ET and analysed the clinical data of the neonates and infants. Study on the influence of blood group antibody factors on the effect of newborn compatible transfusion.\u003c/p\u003e\u003cp\u003eThe efficiency of ET is calculated by the formula: (Pre-ET value - Post-ET value) / Pre-ET value \u0026times; 100%.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatients and equipments\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBetween March 2011 to July 2024, a total of 273 newborns hospitalized for hyperbilirubinemia received ET treatment. They were divided into the BGAbN ET group (n\u0026thinsp;=\u0026thinsp;148) and the BGAbP ET group (n\u0026thinsp;=\u0026thinsp;125).\u003c/p\u003e\u003cp\u003eData on 280 neonatal cases of hyperbilirubinemia ET in the Department of Neonatology, a premier Tertiary Maternity and Children's Hospital of Fujian Province, from March 2011 to July 2024 were collected, of which 273 met the inclusion criteria. They were divided into BGAbN ET (n\u0026thinsp;=\u0026thinsp;148) and BGAbP ET (n\u0026thinsp;=\u0026thinsp;125) groups.\u003c/p\u003e\u003cp\u003eThe test instrument used for bilirubin was the Abbott al16200 (Abbott, Chicago, USA). The number of platelets was detected using the instrument Sysmex\u0026reg;XN-3000 (Sysmex Corporation, Kobe, Japan). The instrument used for blood type and neonatal haemolysis tests was the WADiana DG-57 (Diagnostic Grifols, Barcelona, Spain).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBlood selection and dosage\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNewborns with ABO hemolysis were administered O-type RBCs and AB-type fresh frozen plasma. In Rh hemolysis cases, infants received ABO and Rh-compatible blood products. Blood was meticulously cross-matched, adhering to a standard volume of 160\u0026ndash;180 mL/kg body weight for precise and safe transfusion.\u003c/p\u003e\u003cp\u003eET were executed via a peripheral arteriovenous double-lumen catheter, with the scalp vein for infusion and the radial artery for blood extraction. The ET volume was strictly maintained at 160\u0026ndash;180 mL/kg body weight, ensuring a minimal volume discrepancy of 3\u0026ndash;5 mL/kg between infused and withdrawn blood. The infusion rate was meticulously regulated at approximately 5 mL/kg per minute, with the procedure typically lasting 1.5 to 2 hours. To prevent hypocalcemia, a calibrated 1 mL of 10% calcium gluconate solution was administered for every 100 mL of blood exchanged.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were performed using SPSS Statistics version 27.0 (Armonk, NY, USA). The measurement data are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (i.e.\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), using the paired sample t-test and independent sample t-test, chi-squared test for the analysis of normative comparisons. P-values less than 0.05 were considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 273 newborns with severe hyperbilirubinemia with ET. Among the included cases, there were 164 males and 109 females; the gestational age was 33\u0026ndash;41 weeks; the birth weight was 1.6\u0026ndash;4.3 kg. The newborns were divided into BGAbN ET group with 148 cases and BGAbP ET group with 125 cases. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe analysis of STB, SIB and PLT pre- and post-ET\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSTB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSIB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePLT\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre- ET\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e471.51\u0026thinsp;\u0026plusmn;\u0026thinsp;93.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e438.89\u0026thinsp;\u0026plusmn;\u0026thinsp;87.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e262.66\u0026thinsp;\u0026plusmn;\u0026thinsp;98.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePost-ET\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e256.26\u0026thinsp;\u0026plusmn;\u0026thinsp;67.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e238.93\u0026thinsp;\u0026plusmn;\u0026thinsp;64.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93.17\u0026thinsp;\u0026plusmn;\u0026thinsp;40.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSTB: Serum Total Bilirubin (umol/L); SIB: Serum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe study population was categorized into two cohorts: a BGAbN ET group comprising 148 cases and a BGAbP ET group with 125 cases. Among the BGAbN ET group, there was a significant reduction in the levels of STB, SIB, and PLT, with STB declining from 504.45\u0026thinsp;\u0026plusmn;\u0026thinsp;85.07 to 268.98\u0026thinsp;\u0026plusmn;\u0026thinsp;72.19, SIB from 467.91\u0026thinsp;\u0026plusmn;\u0026thinsp;79.41 to 249.71\u0026thinsp;\u0026plusmn;\u0026thinsp;67.83, and PLT from 278.92\u0026thinsp;\u0026plusmn;\u0026thinsp;104.33 to 96.86\u0026thinsp;\u0026plusmn;\u0026thinsp;40.56. The BGAbP ET group exhibited a parallel trend, with STB levels dropping from 432.50\u0026thinsp;\u0026plusmn;\u0026thinsp;87.29 to 241.20\u0026thinsp;\u0026plusmn;\u0026thinsp;58.79, SIB from 406.72\u0026thinsp;\u0026plusmn;\u0026thinsp;84.71 to 226.15\u0026thinsp;\u0026plusmn;\u0026thinsp;58.57, and PLT from 243.40\u0026thinsp;\u0026plusmn;\u0026thinsp;88.43 to 88.79\u0026thinsp;\u0026plusmn;\u0026thinsp;39.86. The decreases observed in STB, SIB, and PLT for both groups were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe analysis of STB, SIB and PLT pre- and post-ET in the BGAbN and BGAbP groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eBGAbN (148)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eBGAbP (125)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre-ET\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-ET\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre-ET\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePost-ET\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSTB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e504.45\u0026thinsp;\u0026plusmn;\u0026thinsp;85.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e268.98\u0026thinsp;\u0026plusmn;\u0026thinsp;72.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e432.50\u0026thinsp;\u0026plusmn;\u0026thinsp;87.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e241.20\u0026thinsp;\u0026plusmn;\u0026thinsp;58.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e467.91\u0026thinsp;\u0026plusmn;\u0026thinsp;79.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e249.71\u0026thinsp;\u0026plusmn;\u0026thinsp;67.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e406.72\u0026thinsp;\u0026plusmn;\u0026thinsp;84.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e226.15\u0026thinsp;\u0026plusmn;\u0026thinsp;58.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e278.92\u0026thinsp;\u0026plusmn;\u0026thinsp;104.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e96.86\u0026thinsp;\u0026plusmn;\u0026thinsp;40.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e243.40\u0026thinsp;\u0026plusmn;\u0026thinsp;88.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e88.79\u0026thinsp;\u0026plusmn;\u0026thinsp;39.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eSTB: Serum Total Bilirubin (umol/L); SIB: Serum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion; BGAbN: Blood group antibody negative; BGAbP: Blood group antibody positive.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA comparative study on ET efficiency between two groups revealed that the BGAbN group and BGAbP group exhibited ET efficiencies for STB, SIB, and PLT of 46.44\u0026thinsp;\u0026plusmn;\u0026thinsp;12.37, 46.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.41, 62.56\u0026thinsp;\u0026plusmn;\u0026thinsp;15.24 and 43.54\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17, 43.70\u0026thinsp;\u0026plusmn;\u0026thinsp;11.63, 60.75\u0026thinsp;\u0026plusmn;\u0026thinsp;17.87, respectively. Notably, a statistically significant difference in the STB exchange efficiency was identified between the two group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe efficacy of ET in the STB, SIB and PLT among the BGAbN and BGAbP groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExchange Transfusion Efficiency (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBGAbN (148)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBGAbP (125)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSTB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e46.44\u0026thinsp;\u0026plusmn;\u0026thinsp;12.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.54\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e46.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.70\u0026thinsp;\u0026plusmn;\u0026thinsp;11.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e62.56\u0026thinsp;\u0026plusmn;\u0026thinsp;15.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e60.75\u0026thinsp;\u0026plusmn;\u0026thinsp;17.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.367\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSerum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion; BGAbN: Blood group antibody negative; BGAbP: Blood group antibody positive.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eUpon a gender-stratified analysis within the BGAbN and BGAbP groups, it was observed that the BGAbN group included 98 males and 50 females, whereas the BGAbP group had 66 males and 59 females. The ET efficiencies for STB, SIB, and PLT among male participants in the BGAbN and BGAbP groups were 45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.01, 44.86\u0026thinsp;\u0026plusmn;\u0026thinsp;13.41, 62.47\u0026thinsp;\u0026plusmn;\u0026thinsp;15.41, and 43.80\u0026thinsp;\u0026plusmn;\u0026thinsp;12.06, 43.82\u0026thinsp;\u0026plusmn;\u0026thinsp;12.30, 61.44\u0026thinsp;\u0026plusmn;\u0026thinsp;15.49, respectively. No statistically significant differences were noted between the two groups for these parameters (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In contrast, among female participants, the blood exchange efficiencies were 49.25\u0026thinsp;\u0026plusmn;\u0026thinsp;12.70, 49.19\u0026thinsp;\u0026plusmn;\u0026thinsp;13.08, 62.74 \u0026thinsp;\u0026plusmn;\u0026thinsp;15.07 for the BGAbN group and 43.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18, 43.57\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94, 59.98 \u0026thinsp;\u0026plusmn;\u0026thinsp;20.31 for the BGAbP group. Statistically significant differences were identified in the exchange efficiencies of STB and SIB between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas the differences in PLT exchange efficiency were not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).((Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe efficacy of ET in the STB, SIB and PLT among the BGAbN and BGAbP groups by gender\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eExchange Transfusion Efficiency (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBGAbN (98)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBGAbP (66)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBGAbN (50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBGAbP (59)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSTB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.80\u0026thinsp;\u0026plusmn;\u0026thinsp;12.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.529\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e49.25\u0026thinsp;\u0026plusmn;\u0026thinsp;12.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e43.25\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSIB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e44.86\u0026thinsp;\u0026plusmn;\u0026thinsp;13.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e43.82\u0026thinsp;\u0026plusmn;\u0026thinsp;12.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e49.19\u0026thinsp;\u0026plusmn;\u0026thinsp;13.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e43.57\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e62.47\u0026thinsp;\u0026plusmn;\u0026thinsp;15.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e61.44\u0026thinsp;\u0026plusmn;\u0026thinsp;15.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.676\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e62.74\u0026thinsp;\u0026plusmn;\u0026thinsp;15.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e\u003cp\u003e59.98\u0026thinsp;\u0026plusmn;\u0026thinsp;20.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.428\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eSTB: Serum Total Bilirubin (umol/L); SIB: Serum Indirect Bilirubin (umol/L); PLT: Platelet count (10^9/L); ET: Exchange transfusion; BGAbN: Blood group antibody negative; BGAbP: Blood group antibody positive.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSevere neonatal hyperbilirubinemia (SNH) is a significant cause of hospitalization and readmission within the first week of life globally [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It is a prevalent neonatal condition with various etiologies, including infections, enzymatic deficiencies, blood group incompatibilities, and idiopathic cases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Kernicterus, an extreme form of jaundice, poses a severe threat to the nervous system and can result in adverse outcomes such as death or disability in critical cases [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. ET is a crucial intervention for SNH, involving the strategic replacement of the infant's blood or blood components with donor blood or products [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study critically examines the factors influencing the effectiveness of ET in managing severe neonatal hyperbilirubinemia, with a specific emphasis on the impact of blood group antibodies and gender. Following ET, a notable decrease in STB, SIB, and PLT levels was observed [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, a detailed comparison between the BGAbN and BGAbP groups revealed a nuanced outcome, with the BGAbN group showing higher ET efficacy, as evidenced by a more significant reduction in STB levels. This outcome implies that the presence of blood group antibodies might hinder the optimal effectiveness of ET, a concept supported by prior research underscoring the role of ABO and Rh incompatibility in hemolysis and bilirubin production [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe gender-based analysis revealed notable findings. Female neonates in the BGAbP group exhibited a significant reduction in STB and SIB levels following ET, a trend not evident in male neonates or the BGAbN group. The specific mechanisms contributing to this gender disparity are currently unknown. Hormonal, immunological, or genetic influences may potentially impact the response to ET in female neonates. [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These findings point to potential gender-related differences in bilirubin metabolism that may affect the response to ET, a possibility that warrants further investigation.\u003c/p\u003e\u003cp\u003eThe findings of our study hold significant clinical implications for the treatment of severe hyperbilirubinemia in neonates. It is recommended to routinely screen for blood group antibodies in neonates with hyperbilirubinemia to identify individuals who may benefit from more intensive therapeutic measures. Additionally, when developing exchange transfusion protocols, the gender of the neonate should be taken into account, particularly for female neonates with blood group antibodies who may exhibit increased susceptibility to the negative consequences of hyperbilirubinemia.\u003c/p\u003e\u003cp\u003eA significant limitation of this study is the skewed distribution of gestational age and birth weight among the participants, as stratification based on these variables was lacking for a more thorough analysis. Important factors such as gestational age, birth weight, and other clinical variables that may impact bilirubin levels and ET outcomes were not considered.\u003c/p\u003e\u003cp\u003eSubsequent research endeavors should strive to overcome these limitations by conducting prospective studies with broader and more varied participant groups. These studies should delve into the biological mechanisms that underlie the noted gender variations in response to ET, potentially exploring genetic, hormonal, and metabolic influences. [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study provides important insights into the complex interplay between blood group antibodies, gender, and ET efficacy in the management of severe hyperbilirubinemia in neonates. The results emphasize the need for personalized clinical strategies that take into account individual patient characteristics to optimize therapeutic outcomes. By incorporating these findings into clinical practice, we can improve the care and prognosis of neonates with hyperbilirubinemia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors would like to thank the Blood Transfusion Department, Affiliated Hospital of Putian Uniwersity. Putian, Fujian, China for helping to perform part of this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by Qingting Chen, date \u0026nbsp;collation, analysis and statistics were performed by \u0026nbsp;Kunhai wu, Huifang Huang. The first draft of the manuscript was written by \u0026nbsp;Qingting Chen, Kunhai wu. Jianyuan Liao provided research ideas, Lifang Zhang revised the manuscript, oversaw and supervised the work by Xiufeng Xu, Lufe Cheni was responsible for coordination. All authors contributed to critical review and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe date used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll images and data in the manuscript are original creations by us, and we possess full copyright for them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflict of interest\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki and was approval by the Institutional Research Ethics Committee of Affiliated Hospital of Putian Uniwersity, Ethical batch number: 2025175 . Informed consent was waived because the patients\u0026rsquo; data were collected retrospectively. All patients\u0026rsquo; data were anonymized before analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBhutani VK, Maisels MJ, Schutzman DL, et al. Identification of risk for neonatal haemolysis. ACTA PAEDIATR. 2018;107(8):1350\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManagement of hyperbilirubinemia. in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297\u0026ndash;316.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkulu E, Erdeve \u0026Ouml;, Tuncer O, et al. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr. 2021;56(2):121\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGao XY, Huang H, Li LD. [Hemolytic disease of neonates due to anti-M: report of one case and review of reports of 21 cases]. Zhonghua Er Ke Za Zhi. 2009;47(9):648\u0026ndash;52. PMID: 20021783.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang N, Qian L, Lin G, et al. Maternal blood parameters and risk of neonatal pathological jaundice: a retrospective study. Sci Rep. 2023;13(1):2627.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGao XY, Huang H, Li LD. [Hemolytic disease of neonates due to anti-M: report of one case and review of reports of 21 cases]. Zhonghua Er Ke Za Zhi. 2009;47(9):648\u0026ndash;52. PMID: 20021783.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkulu E, Erdeve \u0026Ouml;, Tuncer O, et al. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr. 2021;56(2):121\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGirelli G, Antoncecchi S, Casadei AM, et al. Recommendations for transfusion therapy in neonatology. BLOOD TRANSFUS-ITALY. 2015;13(3):484\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103(1):6\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang N, Qian L, Lin G, et al. Maternal blood parameters and risk of neonatal pathological jaundice: a retrospective study. Sci Rep. 2023;13(1):2627.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatrics. 1998;101(6):995\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarkham KB, Rossi KQ, Nagaraja HN et al. Hemolytic disease of the fetus and newborn due to multiple maternal antibodies. AM J OBSTET GYNECOL. 2015; 213 (1): 68.e1-68.e5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVelkova E. Correlation between the Amount of Anti-D Antibodies and IgG Subclasses with Severity of Haemolytic Disease of Foetus and Newborn. Open Access Maced J Med Sci. 2015;3(2):293\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeydarian F, Majdi M. Severe neonatal hyperbilirubinemia; causes and contributing factors leading to exchange transfusion at Ghaem Hospital in Mashhad. Acta Med Iran. 2010;48(6):399\u0026ndash;402. PMID: 21287481.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlusanya BO, Akande AA, Emokpae A, et al. Infants with severe neonatal jaundice in Lagos, Nigeria: incidence, correlates and hearing screening outcomes. TROP MED INT HEALTH. 2009;14(3):301\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. NEW ENGL J MED. 2001;344(8):581\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhutani VK, Zipursky A, Blencowe H, et al. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. PEDIATR RES. 2013;74(Suppl 1):86\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurke BL, Robbins JM, Bird TM, et al. Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988\u0026ndash;2005. Pediatrics. 2009;123(2):524\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBattersby C, Michaelides S, Upton M, et al. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open. 2017;7(5):e016050.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVidavalur R, Devapatla S. Trends in hospitalizations of newborns with hyperbilirubinemia and kernicterus in United States: an epidemiological study. J MATERN-FETAL NEO M. 2021;35(25):7701\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhatt P, Parmar N, Ayensu M, et al. Trends and Resource Use for Kernicterus Hospitalizations in the United States. Hosp Pediatr. 2022;12(6):e185\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim MS, Chung Y, Kim H, et al. Neonatal exchange transfusion: Experience in Korea. TRANSFUS APHER SCI. 2020;59(3):102730.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkulu E, Erdeve \u0026Ouml;, Tuncer O, et al. Exchange transfusion for neonatal hyperbilirubinemia: A multicenter, prospective study of Turkish Neonatal Society. Turk Arch Pediatr. 2021;56(2):121\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSenterre T, Minon JM, Rigo J, [Neonatal. ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care]. ARCH Pediatr. 2011;18(3):279\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMetcalf RA, Khan J, Andrews J, et al. Severe ABO Hemolytic Disease of the Newborn Requiring Exchange Transfusion. J PEDIAT HEMATOL ONC. 2019;41(8):632\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSarici SU, Saldir M. Genetic factors in neonatal hyperbilirubinemia and kernicterus. TURKISH J PEDIATR. 2007; 49 (3): 245-9. PMID: 17990575.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDonneborg ML, Hansen BM, Vandborg PK, et al. Extreme neonatal hyperbilirubinemia and kernicterus spectrum disorder in Denmark during the years 2000\u0026ndash;2015. J PERINATOL. 2020;40(2):194\u0026ndash;202.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLai NM, Gerard JP, Ngim CF, et al. The Association between Serum Bilirubin and Kernicterus Spectrum Disorder: A Systematic Review and Meta-Analysis. NEONATOLOGY. 2021;118(6):654\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJain A, Malhotra S, Marwaha N, et al. Severe ABO hemolytic disease of fetus and newborn requiring blood exchange transfusion. ASIAN J TRANSF SCI. 2018;12(2):176\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDufour DR, Monoghan WP. ABO hemolytic disease of the newborn. A retrospective analysis of 254 cases. AM J CLIN PATHOL. 1980;73(3):369\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMetcalf RA, Khan J, Andrews J, et al. Severe ABO Hemolytic Disease of the Newborn Requiring Exchange Transfusion. J PEDIAT HEMATOL ONC. 2019;41(8):632\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"italian-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"itjp","sideBox":"Learn more about [Italian Journal of Pediatrics](http://ijponline.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ITJP/default.aspx","title":"Italian Journal of Pediatrics","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Blood group antibody, Exchange transfusion, Hyperbilirubinemia, Neonate","lastPublishedDoi":"10.21203/rs.3.rs-7044497/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7044497/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eExchange transfusion (ET) is the most rapid and effective intervention for neonatal hyperbilirubinemia. This study examines the impact of blood group antibodies on the efficacy of ET in treating severe hyperbilirubinemia, aiming to inform clinical strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and methods: \u003c/strong\u003eBetween March 2011 and July 2024, 273 hyperbilirubinemic newborns underwent ET. They were divided into blood group antibody negative (BGAbN) and positive (BGAbP) groups. Serum total bilirubin (STB), serum indirect bilirubin (SIB), and platelet count (PLT) were assessed before and after ET to compare its effectiveness between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Following ET, a significant decrease in STB, SIB, and PLT levels was noted in both groups (P.05). Gender-based analysis indicated no notable variations in STB, SIB, and PLT levels between the two ET groups in males (P\u0026gt;.05); nevertheless, females in the BGAbN group displayed significantly lower STB and SIB levels post-ET (P\u0026lt;.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eET stands out as the most immediate and effective treatment for severe neonatal hyperbilirubinemia. The presence of blood group antibodies and neonatal gender impact the efficacy of ET.\u003c/p\u003e","manuscriptTitle":"Impact of Exchange Transfusion in Neonatal Hyperbilirubinemia: A Contrast Between Non-blood Group and Blood Group Antibody-induced​","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 14:58:13","doi":"10.21203/rs.3.rs-7044497/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-01-21T15:44:56+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T15:37:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-09T04:09:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Italian Journal of Pediatrics","date":"2025-07-08T03:33:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"italian-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"itjp","sideBox":"Learn more about [Italian Journal of Pediatrics](http://ijponline.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ITJP/default.aspx","title":"Italian Journal of Pediatrics","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a7873c07-a03e-4c70-9738-cd6ccc1834b8","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-18T14:58:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 14:58:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7044497","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7044497","identity":"rs-7044497","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}