Neonatal jaundice, particularly unconjugated hyperbilirubinemia, is a common condition that can lead to bilirubin-induced neurologic dysfunction (BIND) if severe. While physiological jaundice is typically benign, exaggerated forms may require interventions such as phototherapy or exchange transfusion. This retrospective case series analyzed medical records from January 2020 to January 2023 at Northwest General Hospital, Peshawar, including neonates with physiological hyperbilirubinemia (serum bilirubin 17 mg/dL) who underwent exchange transfusion. Out of 136 neonates with exaggerated physiological jaundice, 20 (14.7%) required exchange transfusion, with a mean age at presentation of 5.2 ± 1.9 days; 61.9% were male and 81% were full-term, while exclusive breastfeeding was reported in 76.2% of cases. The mean total serum bilirubin level decreased from 26.52 ± 7.7 mg/dL at admission to 14.16 ± 2.6 mg/dL after transfusion. Exclusive breastfeeding, low birth weight, and prematurity were identified as major contributing factors. These findings highlight the importance of early identification, close monitoring, and timely management to reduce the need for aggressive interventions in this vulnerable population.

Arif is a highly experienced Consultant Neonatologist and Pediatric Intensivist at Northwest General Hospital and a Professor of Pediatrics at Northwest School of Medicine. He has been at the forefront of pediatric healthcare in Peshawar, Pakistan, and has made significant contributions to the field, particularly in neonatal intensive care and pediatric intensive care. He has gained invaluable experience through his training in the UK and Ireland, including a fellowship in Neonatology from Medway Maritime Hospital, England. His expertise has been instrumental in establishing and leading the pediatric and neonatal services at Northwest General Hospital and Research Center.