Values of early diagnosis of neonatal ABO hemolytic disease with cord blood to prevent severe hyperbilirubinemia

Objective To explore the values of prevention of severe hyperbilirubinemia through early diagnosis of neonatal ABO hemolytic disease by cord blood direct antiglobulin test (DAT) and antibody release test. Methods A total of 655 late preterm and full term infants were chosen as study subjects. They were diagnosed as ABO hemolytic disease from June 2013 to June 2016 in Department of Neonatology in West China Second University Hospital, Sichuan University. A total of 188 cases of ABO hemolytic disease neonates who were diagnosed with cord blood DAT and antibody release test at birth were assigned into observation group, and 467 ABO hemolytic disease neonates who were diagnosed with venous blood DAT and antibody release test after admitted to hospital were assigned into control group. Case informations of two groups were retrospectively analyzed. The general clinical data, main indexes of laboratory examination results, treatments, and short term prognosis were statistically compared between two groups by t test or chi-square test. All guardians of research subjects signed the informed consents. Results ①The age of admission to hospital and discovery of jaundice in observation group were all younger than those in control group [(34.3±21.8) h vs (58.8±34.3) h, (22.0±12.8) h vs (32.3±19.0) h, respectively], the levels of total serum bilirubin (TSB) and hemoglobin (Hb) in observation group were lower than those in control group [(185.5±49.2) μmol/L vs (243.3±85.1) μmol/L, (147.3±21.6) g/L vs (153.8±24.9) g/L, respectively], proportion of cesarean section in observation group was higher than that in control group (70.2% vs 56.5%), and all the differences above were statistically significant (t=9.071, P<0.001; t=6.831, P<0.001; t=8.743, P<0.001; t=3.132, P=0.002; χ2=10.492, P=0.001). ②The blood exchange transfusion rates and albumin usage rates in observation group were all lower than those in control group (0 vs 9.0%, 9.6% vs 22.5%, respectively), and the differences were statistically significant (χ2=18.532, P<0.001; χ2=15.151, P<0.001). ③A total of 7 neonates with bilirubin encephalopathy were all in control group. Conclusions Screening ABO hemolytic disease by cord blood DAT and antibody release test at birth can strengthen physicians and guardians′ awareness of jaundice monitoring of neonatal ABO hemolytic disease, and to find out the infants who need phototherapy, to avoid severe hyperbilirubinemia and bilirubin encephalopathy which need blood exchange transfusion therapy. Key words: ABO blood-group system; Blood group incompatibility; Fetal blood; Hyperbilirubinemia; Kernicterus; Infant, newborn