CPT® Code 36456

1. Indications

The partial exchange transfusion procedure is indicated for the following conditions in newborns:

• Polycythemia - A condition characterized by an increased concentration of red blood cells in the blood, which can lead to complications if not addressed.
• Anemia - A deficiency in the number or quality of red blood cells, leading to reduced oxygen transport in the body.
• Hyperbilirubinemia - An excess of bilirubin in the blood, which can cause jaundice and other complications in newborns.
• Large or small for gestational age - Newborns that are significantly larger or smaller than the average size for their gestational age may be at risk for hematological issues.
• Intrauterine growth retardation - A condition where a fetus does not grow to normal weight during pregnancy, potentially leading to complications after birth.
• Trisomy 21 - A genetic disorder also known as Down syndrome, which can be associated with various health issues, including blood disorders.
• Twin-to-twin transfusion syndrome - A condition that can occur in identical twins where blood flow is imbalanced between the twins, leading to complications.
• Beckwith-Wiedemann syndrome - A growth disorder that can increase the risk of certain hematological conditions.
• Delayed cord clamping - A practice that may lead to increased blood volume in the newborn, potentially resulting in polycythemia.
• Maternal diabetes - A condition in the mother that can affect the newborn's blood characteristics and increase the risk of anemia or polycythemia.

2. Procedure

The procedure for a partial exchange transfusion involves several critical steps to ensure the safe and effective treatment of the newborn. The first step is the placement of thin catheters into the blood vessels of the newborn, which can be done through either the umbilical artery or umbilical vein. This is essential for accessing the circulatory system to perform the exchange. Once the catheters are in place, a calculated volume of blood is withdrawn from the selected umbilical vessel over a period of 2-3 minutes. This step is crucial as it allows for the removal of excess blood that may be contributing to conditions such as polycythemia. Following the withdrawal, the same volume of warmed blood, plasma, or crystalloid fluid is then infused back into the newborn through the same vessel, utilizing the push-pull technique. Alternatively, if a two-catheter method is employed, the infusion can occur through a second catheter placed in the other umbilical vessel. This cycle of withdrawing and infusing continues until the desired volume of blood has been exchanged, effectively replacing the removed blood with the appropriate fluid to correct the newborn's hematological condition. In cases where a peripheral vein is used in conjunction with an umbilical vessel, the process is simultaneous, with blood being withdrawn from the umbilical vessel while the replacement fluid is infused through the peripheral vein, ensuring a continuous and controlled exchange.

3. Post-Procedure

After the completion of the partial exchange transfusion, careful monitoring of the newborn is essential to assess for any potential complications or adverse reactions. The healthcare team will observe the newborn for signs of improvement in their hematological status, including monitoring bilirubin levels and overall blood counts. Additionally, the newborn may require further assessments to ensure that the exchange has effectively addressed the initial conditions of polycythemia, anemia, or hyperbilirubinemia. Post-procedure care may also involve providing supportive measures, such as maintaining appropriate warmth and hydration, and ensuring that the newborn is stable before discharge. Continuous follow-up may be necessary to evaluate the long-term effects of the procedure and to monitor for any recurrence of the conditions treated.