A prospective study of 454 newborn babies with pathological
hyperbilirubinemia revealed that in about one-third of cases (34.6%), no cause could be identified despite detailed investigations. Nearly three-fifth of infants (62.5%) had
hyperbilirubinemia due to hemolytic causes. On the basis of four variables, i.e., peak serum
bilirubin level, age of attaining the peak level, age of starting
phototherapy and total duration of
phototherapy, the cases of
hyperbilirubinemia can be categorized into three groups: (a) Group I (mild) included non-hemolytic
hyperbilirubinemia, i.e., idiopathic,
bacterial infections, intrauterine
infections and others, (b) Group II (moderate) comprised of hemolytic as well as non-hemolytic
hyperbilirubinemia due to prematurity, administration of
oxytocin, bruising/cephalhematoma, and (c) Group III (severe) comprised of
hyperbilirubinemia due to
hemolysis as a result of blood group incompatibility between the mother and the neonate and G-6-PD deficiency. Sixty six babies required exchange
blood transfusion (EBT) and a total of 100 EBTs were performed. Most of the babies (80.3%) requiring exchange
blood transfusion belonged to Group III. The most common cause of hemolytic
hyperbilirubinemia needing exchange
blood transfusion was Rh isoimmunization followed by G-6-PD deficiency and ABO isoimmunization. There was no death attributable to the procedure of exchange
blood transfusion.