Comparison of efficacy and safety of exchange transfusion through different catheterizations: Femoral vein versus umbilical vein versus umbilical artery/vein

Objective: To compare the efficacy and safety of exchange transfusion (ET) via three different catheterization methods: femoral vein (FV); umbilical vein (UV); and umbilical artery/vein (Ua/V). Design: A retrospective cohort of neonates who underwent ET for hyperbilirubinemia between 1996 and 2007 was surveyed. Subjects with gestational age <33 wks were excluded. Setting: Neonatal intensive care units in a tertiary referral hospital. Patients: A total of 109 neonates with 128 ET procedures (33 via FV, 35 via UV, and 60 via UA/V routes) were analyzed. Measurements and Main Results: There was no significant difference in the decline of total serum bilirubin between each group. When compared with the UA/V group, the transfusion rate was slower in the FV and UV groups (p < .001). Adverse events with clinical significance were more common in ET via the UA/V route than ET via the FV and UV routes (p < .05; odds ratio, 2.4; 95% confidence interval, 1.2-5.0). Neonates with ET via the UA/V route tended to have more asymptomatic laboratory aberrances (p < .01; odds ratio, 2.5; 95% confidence interval, 1.3-4.6). There were no significant differences in the transfusion rate (p = .498) and adverse events (p = .822) between the FV and UV groups. Conclusions: ET through the FV route is an effective and secure method for the treatment of neonatal hyperbilirubinemia when the UV route is unavailable. Physicians should be cautious when using UA/V catheterization for ET.