![]() ABO incompatibility was the commonest cause (64 cases, 32%) of pathological hyperbilirubinemia, followed by sepsis (42 cases, 21%), while the cause could not be ascertained in 31 (15.5%) of the cases ( Table 1). Of these, 200 fulfilled the inclusion criteria and were investigated. Resultsĭuring the study period, 1208 patients were admitted in the neonatal unit and 233 presented with hyperbilirubinemia. Continuous variable was analyzed using independent Student's t-test and chi-square test/Fisher's exact test was used to test associations between groups. Data were summarized using descriptive statistics. For the statistical analysis of results, SPSS 16.0 software was used. ![]() It was recorded as ‘a day’ when age or duration of phototherapy exceeded 12 h. The phototherapy and exchange transfusion decision for preterm infants 6%), peak TSB level, age (days) at peak TSB, duration of phototherapy provided (days), and need of exchange transfusion and its number. ![]() We considered early exchange transfusion in cases of hydrops in Rh incompatibility, when there was history of previous sibling receiving exchange transfusion, the following were noted: cord blood hemoglobin 5 mg/dl, rate of rise of TSB >1 mg/dl/h despite phototherapy or rise >0.5 mg/dl/h despite phototherapy if hemoglobin is between 11 and 13 gm/dl, any TSB > 12 mg/dl in first 24 h of life, and TSB >20 mg/dl in neonatal period. The TSB level was plotted against postnatal age in hours, gestation, and risk category for starting phototherapy and doing exchange transfusion in infants >35 weeks of gestation. Rh C and Rh E incompatibilities were regarded as a cause of neonatal hyperbilirubinemia when an infant was detected to have Rh C or Rh E antigen, while the mother was found to be negative for the same, in absence of any other explainable reason. Red blood cells possessing the C or E antigens would agglutinate in the presence of the antibodies directed toward the antigens, which are readily detected by naked eye/microscopy. The agglutination test was performed in the Department of Transfusion Medicine using ready-to-use reagents, Eryclone (anti-C and anti-E antibody) from Tulip Diagnostics. ![]() When no ABO and/or Rh D incompatibility scenario was detected ( N = 108), we performed quantitative test for G-6-PD deficiency (by G-Six test) and osmotic fragility test in the infant, and agglutination test in both the infant and the mother to detect Rh C and Rh E antigens on the RBCs. In case if more than one etiology was identified in a patient, the predominant cause leading to hyperbilirubinemia was ascertained by consensus. When both the ABO and Rh D incompatibilities were detected in any patient, it was decided to categorize the patient under Rh D incompatibility group. Similarly, diagnosis of Rh D incompatibility was made when the mother had Rh D negative blood group and the baby was found to be Rh D positive. A diagnosis of ABO incompatibility was made when the mother had blood group ‘O’ and the baby's blood group was either ‘A’ or ‘B’. ![]() Only moderate to severe grade of ABE was noted, based on mental status, muscle tone, and cry.ĭirect antiglobulin test (Coomb's test) by using antihuman globulin reagent was performed in cases having blood group incompatibility and/or evidence of hemolysis. Complete physical examination of the neonate was performed carefully and the data, including weight on admission, maturity, cephalhematoma, and presence of acute bilirubin encephalopathy (ABE), were recorded. History, including mother's age, parity, use of oxytocin injection during labor, period of gestation, past history of blood transfusion/abortion, place of delivery, mode of delivery, mother's blood group (ABO and Rh), predominant feed (mother's milk/other feed) before admission, and age at onset of jaundice, was recorded. Patients having major anomalies, weight <600 g, gestational maturity <26 weeks, and perinatal asphyxia with HIE stage 3, were excluded. The subjects were neonates with pathological unconjugated hyperbilirubinemia requiring phototherapy and/or exchange transfusion. The study was approved by the Institutional Ethics Committee. This was a prospective observational study done at a tertiary care neonatal unit between August 2011 and July 2012. ![]()
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