Neonatal exchange transfusions in hospitals that provide Level II neonatal care

Is it appropriate to perform a neonatal exchange transfusion in a hospital that provides Level II neonatal care (Click HERE for level of care definitions)? Or should such a procedure be done in a higher level of care facility, such as in a NICU? A colleague at a hospital with a 'Level II nursery' wants to know if other facilities with Level II Nurseries perform neonatal exchange transfusions. The blood bank/transfusion service is able to provide the necessary products, but should these patients be transferred to a more specialized nursery, or treated in a higher level NICU setting.

The following comments have been received.

ADDENDA Nov. 29, 2011

1. In response, Rangasamy Ramanathan, MD, Director of the NICU at LAC+USC Medical Center (attribution used with permission) states that Level II NICUs should be able to perform exchange transfusions, provided that the blood bank in the hospital is capable of providing appropriate blood products. Professor Ramanathan notes that all neonatologists are trained to perform neonatal exchange transfusions, and he is aware of other facilities with Level II nurseries performing this procedure. He suggests periodic competency training for the NICU staff.

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