Predominance of Rh-mediated haemolytic disease driving exchange transfusions in rural north India: A five-year retrospective analysis revealing critical prevention gaps.

Exchange transfusion remains the definitive treatment for severe neonatal hyperbilirubinaemia; yet its aetiology and outcomes in rural tropical settings are poorly characterised. This five-year retrospective analysis of 58 neonates at a North Indian rural tertiary centre reveals that Rh incompatibility accounted for 76% of cases - a striking divergence from high income-country patterns where ABO incompatibility predominates - indicating critical gaps in antenatal Rh immuno-prophylaxis. The procedure achieved a mean bilirubin reduction of 50% (424 ± 106 to 212 ± 70&mu/L, p < 0.001) with no procedure-related mortality, though clinically significant adverse events occurred in 19% of neonates. Notably, 10.2% presented with acute bilirubin encephalopathy at the time of intervention, representing potentially preventable neurological injury. These findings make a compelling case for urgent, systematic improvements in antenatal screening, Rh immuno-prophylaxis access, and early jaundice recognition in tropical resource-limited settings.