Seems like it is a rarely performed procedure. Would like to get an idea on the prevalence of the procedure where you work. Specifically asking about neonatal, not intrauterine. 

What kind of hospital (beds)? State?  

Are infants requiring one usually transferred to hospitals with higher level NICUs?

 

We perform neonatal exchange transfusions on only one to two patients per year.  We are a large free-standing pediatric facility in Ohio with about 525 beds (includes about 130 inpatient neonatal and 150 offsite neonatal beds).  We provide reconstituted whole blood since we are already FDA registered (see related thread on RWB for exchange txns).  A baby who needs an exchange who is at our offsite neonatal units at our partner adult hospitals should be transferred in-house on main campus for the exchange procedure.  It is a manual push-pull process, usually performed by the NNP in the NICU.  The RWB is not required but does make the process easier for the clinician as opposed to alternating prbcs and plasma.

Stephanie

1 per year or 1 every other year.  Nightmare to maintain competency and training on!  We get the little ones transferred here now  - about a 200 bed hospital with maybe 10 neonate beds.  (and to think we have a Children's hospital and a second huge pedi/neonate service 50 miles to the south of us - it is all a prestige thing, I swear).

I have worked in Transfusion Medicine in the US since 1978, and I recall only one neonatal exchange transfusion.  The baby's mother did not have Rh Immune Globulin after her first child because she wanted a natural pregnancy.  I guess no one told her that there is nothing more natural than death.

We do exchanges on sickle cell patients all the time.

I've seen one in my entire career. Anti-D baby that was too sick to transfer until 2 exchanges were done. Thanks to an old school OB nurse who really knew her stuff and had seen HDN due to anti-D, I had enough warning for the planned C-section to be prepared with a couple of appropriate units.

In 35+ years I saw a few.  Two of them come to mind. The worst case of HDN I saw was due to Anti: c.  The other was my daughter due to Anti:D.  I had one pediatrician who did them with alarming frequency, he wasn't around very long.  The 2 facilities I worked in where exchanges were done were 250-300 beds (depends on who was counting and why).  The latter of the two had a large NICU (don't remember the count but I think it was 35 or 40).  My initial response when first reading the question was, when necessary.  As noted above by everyone, it is infrequent to rare mainly due to the excellent prenatal care currently available.  

It had probably been like 10 years or so since there was a "real" exchange, before that 2 times a year??? But since EH is a training hospital for both MT's and MLT's and it seems like we are always training a new employee a product for the exchange is prepared several times a year

we rarely perform this procedure. I have been in my present position of about 15 years, and we have only performed the exchange 3 times. since we are a level 3 NICU, we are the ones that get these babies.

Just saw this topic - we are 700 bed facility with 35 bed NICU and are the Mother Ship to 5 satellite facilities that offer Labor and Delivery. We probably do 1-2 per year and they seem to come in clusters.  More often than not, there is a panicked phone call ordering exchange transfusion STAT before Bilirubin levels and Hgb are performed.  Did I mention that we are also a teaching facility?  After calling in someone to perform the reconstitution, it is usually cancelled because phototherapy was initiated and the bilirubin levels dropped below the "Exchange Transfusion" threshold.

Other hospitals I have worked at had similar rates of exchanges for infants.

Level 3 NICU and we have done 1 in the last 6 years.

we have a 70 bed NICU in new england; we have about 3 neonatal exchanges each year.

however, we've have had two in the past month; one for maternal:fetal ABO incompatibility (due to B, strangely), and one for anti-D HDN (no hydrops) that they tried to manage first with IVIG but after a couple weeks moved on to an exchange.