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Introduction: This study aims to determine the aetiology and complications of exchange transfusion (ET) performed for neonatal hyperbilirubinaemia in Isfahan, Iran.

Methods: A retrospective chart review of 68 term and near-term newborns who underwent ET at two perinatal centres in Isfahan, Iran between January 2001 and January 2004, was performed.

Results: Of the 68 patients who underwent ET, nine (13.2 percent) required more than one ET. The most common causes of ET overall were ABO incompatibility (22.1 percent) and glucose-6-phosphate dehydrogenase deficiency (19.1 percent). The maximum total serum bilirubin concentration was 25.9+/-7.5 mg/dL. ET complications occurred in 14 neonates (20.9 percent), the most common being thrombocytopenia (6 percent). One (1.5 percent) of the 68 patients died of complications, probably attributable to ET.

Conclusion: ET causes high morbidity, even in term and near-term newborns. Therefore, it should be initiated only when the benefit of preventing kernicterus outweighs the complications associated with the procedure.