Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates
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Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates Ramesh Y Bhat, Pavan CG Kumar Manipal, India
Methods: TcB measurements were obtained at the 6th hour of life in blood group A or B neonates born to blood group O, rhesus factor compatible mothers. Subsequent hyperbilirubinemia was monitored and considered significant if a neonate required phototherapy/exchange transfusion. The predictive role of sixth hour TcB was estimated. Results: Of 144 ABO incompatible neonates, 41(OA, 24; O-B, 17) had significant hyperbilirubinemia. Mean sixth hour TcB was significantly higher among neonates who developed significant hyperbilirubinemia than those who did not (5.83±1.35 mg/dL vs. 3.65±0.96 mg/dL, P4 mg/dL had the highest sensitivity of 93.5% and >6 mg/dL had the highest specificity of 99%. Area under receiver operating characteristic curve was 0.898. Conclusion: Sixth hour TcB predicts subsequent significant hyperbilirubinemia in ABO incompatible neonates. World J Pediatr June 2013; Online First Key words: ABO incompatibility; neonate; phototherapy; significant hyperbilirubinemia; transcutaneous bilirubin
Author Affiliations: Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, India (Bhat RY, Kumar PCG) Corresponding Author: Ramesh Y Bhat, Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal-576104, Udupi District, Karnataka, India (Tel: 91 9448296564; Fax: 91 820 2571927; Email: [email protected]) doi: 10.1007/s12519-013-0421-5 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2013. All rights reserved.
World J Pediatr, Online First, June 2013 . www.wjpch.com
Introduction
N
eonatal hyperbilirubinemia is the most common cause for readmissions within days after initial discharge.[1-4] Hemolytic jaundice accounts for 20% of all significant jaundice in newborns, and ABO and Rh incompatibility comprise two thirds of the total.[2] Currently, ABO hemolytic disease (ABO-HD) is the most common cause of neonatal jaundice because of blood group incompatibility.[1-5] Early postnatal discharge of newborns is complicated by subsequent significant hyperbilirubinemia.[1,2,4] Such a risk is greater in newborns with ABO incompatibility.[4] The clinical course of ABO-HD has been studied along with the reticulocyte count, Coombs positivity and/or a strongly positive elution test and the presence of a sibling with neonatal jaundice as predictors.[5-7] However, other studies did not support the use of any routine screening tests in the management of ABO-HD and reported that such tests are not cost effective.[8,9] Early serum bilirubin and reliable transcutaneous bilirubin (TcB) measurements predicting subsequent severe hyperbilirubinemia among term and near term infants have been well documented.[10,11] Sarici et al[4] reported a sixth hour serum bilirubin level predicting nearly all newborns developing subsequent significant hyperbili
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