Evaluation of Neonatal Hemolytic Jaundice: Clinical and Laboratory Parameters
Keywords:hemolytic jaundice, ABO/Rh isoimmunisation, unspecific etiology, laboratory
BACKGROUND: Neonatal jaundice that occurs in ABO or Rhesus issoimunisation has been recognized as one of the major risk factors for development of severe hyperbilirubinemia and bilirubin neurotoxicity.
AIM: Aim of our study was to investigate clinical and laboratory parameters associated with hemolytic jaundice due to Rh and ABO incompatibility and compare results with the group of unspecific jaundice.
MATERIAL AND METHODS: One hundred sixty seven (167) neonatal hyperbilirubinemia cases were included in the study, 24.6% of which presented with ABO/Rhesus type hemolytic jaundice, and the rest with unspecific jaundice. Evaluation included: blood count, reticulocites, serum bilirubin, aminotransferases, blood grouping, and Coombs test, also the day of bilirubin peak, duration of the hyperbilirubinemia, and additional bilirubin measurements.
RESULTS: We showed significantly lower mean values of hemoglobin, erythrocytes and hematocrit and significantly higher values of reticulocytes in the group of ABO/Rh incompatibility compared to the group of jaundice of unspecific etiology; also an earlier presentation and a higher-grade jaundice in this group.CONCLUSIONS: The laboratory profile in ABO/Rh isoimmunisation cases depicts hemolytic mechanism of jaundice. These cases carry a significant risk for early and severe hyperbilirubinemia and are eligible for neurodevelopmental follow-up. Hematological parameters and blood grouping are simple diagnostic methods that assist the etiological diagnosis of neonatal hyperbilirubinemia.
Plum Analytics Artifact Widget Block
Detection and treatment of neonatal jaundice-NICE guideline. Lancet. 2010;29:375(9729)-1845.
Porter ML, and Dennis BL. Hyperbilirubinemia in the term newborn. Am Fam Physician. 2002;65(4):599-607.
Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344(8):581-90.
Kaplan M, Muraca M, Hammerman C, et al. Imbalance between production and conjugation of bilirubin: a fundamental concept in the mechanism of neonatal jaundice. Pediatrics. 2002;110(4):e47.
Watchko JF, Daood MJ, Biniwale M. Understanding neonatal hyperbilirubinemia in the era of genomics. Semin Neonatol. 2002;7(2):143â€“52.
Kaplan M, Hammerman C, Maisels MJ. Bilirubin genetics for the nongeneticist: hereditary defects of neonatal bilirubin conjugation. Pediatrics. 2003;111(4):886â€“93.
Watchko JF, Lin Z, Clark RH, et al. Complex multifactorial nature of significant hyperbilirubinemia in neonates. Pediatrics. 2009;124(5):e868-77.
Lin Z, Fontaine J and Watchko JF. Coexpression of gene polymorphisms involved in bilirubin production and metabolism. Pediatrics. 2008;122(1):e156-62.
American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297â€“316.
Maisels MJ, Bhutani VK, Bogen D, et al. Hyperbilirubinemia in the newborn infant > or =35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-8.
Bhutani VK, Johnson LH, Maisels MJ, et al. Kernicterus: epidemiologic strategies for its prevention through systems-based approaches. J Perinatol. 2004;24(10):650â€“62.
Papazovska Cherepnalkovski A, Piperkova K, Palcevska Kocevska S, et al. Evaluation and management of neonatal indirect hyperbilirubinemia at the University Pediatric Clinic in Skopje, Republic of Macedonia Medicus. 2015;20(2):221â€“29.
Koosha A, Rafizadeh B. Evaluation of neonatal indirect hyperbilirubinaemia at Zanjan Province of Iran in 2001-2003: prevalence of glucose-6-phosphate dehydrogenase deficiency. Singapore Med J. 2007;48(5):424-8.
Curme H, Rand RN. Early history of Eastman Kodak Ektachem slides and instrumentation. Clinical Chemistry. 1997;43(9):1647-52.
Krzelj V, Zlodre S, Terzic J, et al. Prevalence of G-6-PD deficiency in the Croatian Adriatic Coast population. Arch Med Res. 2001;32:454-7.
Beutler E, Blume KG, Kaplan JC, et al. International Committee for standardization in haematology: recommended methods for red cell enzyme analysis. Br J Haematol. 1977;35:331-40.
Alkalay AL, Simmons CF. Hyperbilirubinemia guidelines in newborn infants. Pediatrics. 2005;115(3):824-5.
Bratlid D, Nakstad B, Hansen TW. National guidelines for treatment of jaundice in the newborn. Acta Paediatr. 2011;100(4):499-505.
Beeby P, Evans N. Jaundice. Royal Prince Alfred Hospital Web site. RPA Newborn Care Guidelines. http://www.slhd.nsw.gov.au/rpa/neonatal%5Ccontent/pdf/guidelines/jaundice.pdf. Accessed October 29, 2015.
Maisels MJ, McDonagh AF. Phototherapy for Neonatal Jaundice. N Engl J Med. 2008;358:920-28.
Rennie JM, Sehgal A, De A, Kendall GS, Cole TJ. Range of UK practice regarding thresholds for phototherapy and exchange transfusion in neonatal hyperbilirubinaemia. Arch Dis Child Fetal Neonatal Ed. 2009;94:F323â€“7.
Kaplan M, Bromiker R, Hammerman C. Hyperbilirubinemia, hemolysis, and increased bilirubin neurotoxicity. Semin Perinatol. 2014;38(7):429-37.
Tiker F, Gulcan H, Kilicdag H, Tarcan A, Gurakan B. Extreme hyperbilirubinemia in newborn infants. Clin Pediatr (Phila). 2006;45(3):257-61.
DavutoÄŸlu M, GaripardiÃ§ M, GÃ¼ler E, Karabiber H, Erhan D. The etiology of severe neonatal hyperbilirubinemia and complications of exchange transfusion. Turk J Pediatr. 2010;52(2):163-6.
Hakan N, Zenciroglu A, Aydin M, et al. Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey. J Matern Fetal Neonatal Med. 2014;22:1-5.
Kaplan M, Hammerman C. Severe neonatal hyperbilirubinemia, a potential complication of glucose-6-phosphate dehydrogenase deficiency. Current Controversies in Perinatal Care III. 1998;25(3):575-90.
Kaplan M, Muraca M, Hammerman C, et al. Bilirubin conjugation, reflected by conjugated bilirubin fractions, in glucose-6-phosphate dehydrogenase-deficient neonates: a determining factor in the pathogenesis of hyperbilirubinemia. Pediatrics. 1998;102:E37.
Mishra JP, Mishra J, Padhi RK, Mishra S, Manjareeka M. Hematological profile in neonatal jaundice. J Basic Clin Physiol Pharmacol. 2014;25(2):225-8.
Ip S, Chung M, Kulig J, et al. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004;114(1):e130-53.
How to Cite
All rights reserved.