Document Type : original article
Authors
1 Department of Pediatrics, Diyarbakir Children Hospital, Diyarbakir, Turkey.
2 Department of Pediatric, Dicle University, Diyarbakir, Turkey.
3 Department of Pediatric, Division of Neonatology, Dicle University, Diyarbakir, Turkey.
4 Department of Pediatric, Mardin Derik Public Hospital, Turkey.
Abstract
Background: Hyperbilirubinemia is one of the most serious problems encountered in the newborn period. There are many reasons for newborn jaundice etiology. In this study, we aimed to investigate the frequency of subgroup incompatibilities in the etiology of hyperbilirubinemia, its association with blood group incompatibilities and the treatments given.
Methods: In this retrospective study, we evaluated 240 newborn patients who were diagnosed as hyperbilirubinemia in Dicle University Faculty of Medicine Neonatal Unit between January 2016 and June 2017.
Results: Subgroup incompatibility was detected in 32% of cases. Only 35.4% of cases with subgroup incompatibility were found just subgroup incompatible. Subgroup C incompatibility was found in 43%, Rh incompatibility in 35% and subgroup E incompatibility in 33% of cases. Direct Coombs Test positivity was detected in 38% of cases. Blood exchange procedure was performed in 16.5% of cases with subgroup incompatibility. Blood exchange was applied to 40.9% of those with Rh and C incompatibility. Only 50% of those with Rh and C subgroup incompatibility were applied blood exchange (this group was not accompanied by Rh or ABO incompatibility). Intravenous immunoglobulin treatment was given in 24.1% of cases with subgroup incompatibility in total. Intravenous immunoglobulin treatment was given also to 17.85% of cases with only subgroup incompatibility that did not accompany Rh and ABO incompatibility.
Conclusion: Detection of subgroup blood incompatibilities in cases with neonatal jaundice is important in diagnosis, treatment and follow-up.
Keywords
- Lauer BJ, Spector ND. Hyperbilirubinemia in the newborn. Pediatrics in review. 2011 Aug 1;32(8):341-9.
- Bhutani VK, Vilms RJ, Hamerman-Johnson L. Universal bilirubin screening for severe neonatal hyperbilirubinemia. Journal of perinatology. 2010 Oct;30(1):S6-15.
- Behrman RE, Kliegman RM, Jenson HB. Nelson textbook of pediatrics. 16. Edition, Philadelphia. 2000;12(9):88-102.
- Barrington KJ, Sankaran K, Canadian Paediatric Society, Fetus and Newborn Committee. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants. Paediatrics & Child Health. 2007 Jun 1;12(suppl_B):1B-2B.
- Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S, et al. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004 Jul 1;114(1):e130-53.
- Bhutani VK, Johnson LH, Jeffrey Maisels M, Newman TB, Phibbs C, Stark AR, et al. Kernicterus: epidemiological strategies for its prevention through systems-based approaches. Journal of perinatology. 2004 Oct;24(10):650-62.
- Moise KJ. Fetal anemia due to non-Rhesus-D red-cell alloimmunization. InSeminars in fetal and neonatal medicine 2008 Aug 1 (Vol. 13, No. 4, pp. 207-214). WB Saunders.
- Çelik K, Koker SA, Özkul MT, Olukman Ö, Karapinar TH, Vergin RC, et al. Impact of Minor Blood Group Incompatibility Versus ABO and Rh Blood Group Incompatibility in Newborns with Indirect Hyperbilirubinaemia: A Single-Centre Clinical Experience. HK J Paediatr (new series). 2019 Jul 1;24(3):120-6.
- Kaplan M, Bromiker R, Hammerman C. Severe neonatal hyperbilirubinemia and kernicterus: are these still problems in the third millennium?. Neonatology. 2011 Oct 3;100(4):354-62.
- Singh SK, Singh SN, Kumar M, Tripathi S, Bhriguvanshi A, Chandra T, et al. Etiology and clinical profile of neonates with pathological unconjugated hyperbilirubinemia with special reference to Rhesus (Rh) D, C, and E incompatibilities: A tertiary care center experience. Clinical Epidemiology and Global Health. 2016 Jun 1;4(2):95-100.
- Ozkaya H, Bahar A, Ozkan A, Karademir F, Gocmen I, Mete Z. ABO, RH and subgroup (Kell, c, e) incompatibilities in newborns with indirect hyperbilirubinemia. Turk J Pediatr. 2000;35:30-5.
- Duguid JK. ACP Broadsheet No 150. March 1997. Antenatal serological testing and prevention of haemolytic disease of the newborn. Journal of clinical pathology. 1997 Mar;50(3):193.
- American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004 Jul;114(1):297-316.
- Pace EJ, Brown CM, DeGeorge KC. Neonatal hyperbilirubinemia: An evidence-based approach. J Fam Pract. 2019 Jan 1;68(1):E4-11.
- Murki S, Kumar P. Blood exchange transfusion for infants with severe neonatal hyperbilirubinemia. InSeminars in perinatology 2011 Jun 1 (Vol. 35, No. 3, pp. 175-184). WB Saunders.
- Wagemann SC, Nannig PM. Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes. Rev. chil. pediatr. Santiago. 2019 Jun;90(3):267-74.
- Aslan Y, Erduran E, Gedik Y, Mocan H, Yıldıran A, Soylu HK. E subgroup incompatibilities in neonates with indirect hyperbilirubinemia. Turkey Clin J Pediatr 1996; 5 (3): 93. 1996;8.
- Karagol BS, Zenciroglu A, Okumus N, Karadag N, Dursun A, Hakan N. Hemolytic disease of the newborn caused by irregular blood subgroup (Kell, C, c, E, and e) incompatibilities: report of 106 cases at a tertiary-care centre. American journal of perinatology. 2012 Jun;29(06):449-54.
- Sgro M, Campbell D, Shah V. Incidence and causes of severe neonatal hyperbilirubinemia in Canada. Cmaj. 2006 Sep 12;175(6):587-90.
- Vućinović M, Jadrić H, Karelović D, Roje D, Haspl-Hundrić Z, Hrgović Z, et al. Haemolytic disease of the newborn--from a mother with anti-Kell, anti-E and anti-Vel anti-erythrocyte alloantibodies. Zeitschrift fur Geburtshilfe und Neonatologie. 2004 Oct 1;208(5):197-202.
- Deveci N. İndirekt hiperbilirubinemili yenidoğanlarda ABO, RH ve subgrup uyuşmazlıkları, 2003.
- Rübo J, Albrecht K, Lasch P, Laufkötter E, Leititis J, Marsan D, et al. High-dose intravenous immune globulin therapy for hyperbilirubinemia caused by Rh hemolytic disease. The Journal of pediatrics. 1992 Jul 1;121(1):93-7.
- Riskin A, Abend-Weinger M, Bader D. How accurate are neonatologists in identifying clinical jaundice in newborns?. Clinical pediatrics. 2003 Mar;42(2):153-8.
- Hansen TW. Pioneers in the scientific study of neonatal jaundice and kernicterus. Pediatrics. 2000 Aug 1;106(2):e15-.
- Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality. Pediatrics. 2007 Jul 1;120(1):27-32.
- Subcommittee on Neonatal Hyperbilirubinemia. Neonatal jaundice and kernicterus: American Academy of Pediatrics. Pediatrics. 2001;108(3).
- Badiee Z. Exchange transfusion in neonatal hyperbilirubinaemia: experience in Isfahan, Iran. Singapore medical journal. 2007 May 1;48(5):421.
- Sarici SU, Alpay F, YeÅŸilkaya E, Ozcan O, Gökçay E. Hemolytic disease of the newborn due to isoimmunization with anti-E antibodies: a case report. The Turkish journal of pediatrics. 2002 Jul 1;44(3):248-50.
- Liley HG. Immune hemolytic disease of the newborn. Nathan and Oski's Hematology of Infancy and Childhood E-Book. 2008 Jan 1:67.
- Van Dijk BA, Hirasing RA, Overbeeke MA. Hemolytic disease of the newborn and irregular blood group antibodies in the Netherlands: prevalence and morbidity. Nederlands Tijdschrift Voor Geneeskunde. 1999 Jul 1;143(28):1465-9.
- Annagür A, Altunhan H, Konak M, Koç H, Örs R. Role of subgroup incompatibility in newborn jaundice requiring exchange transfusion. European Journal of General Medicine. 2014 Jun 28;11(2):2-6.