ISSN - 0973-0958
Direct Coomb’s Test in Hyperbilirubinemia of the Newborn
Pradeep Kumar B1, Shashidhar A1, Sitalakshmi D2, Suman Rao PN1.
1Departments of Neonatology, St. John's Medical College, Bangalore, India,
2Transfusion Medicine, St. John's Medical College, Bangalore, India.
Aim: To evaluate the association of hyperbilirubinemia and Direct Coomb’s Test (DCT) in ABO/ Rh incompatibility setting.
Methods: A comparative study of DCT positive and DCT negative newborns by retrospective chart review was done in a tertiary care neonatal center of Southern India between January 2015 to December 2016. Bilirubin levels, phototherapy duration, intravenous immunoglobulin (IVIG) use, exchange transfusion rates were compared between the 2 groups.
Results: Out of the 140 babies reviewed, 36 (25.7%) newborns were DCT positive and 104 (74.3%) were DCT negative. Bilirubin centile >95th centile was seen in 16 (44.5%) in DCT positive and 18 (17.5%) in DCT negative group (p=0.009). Babies in DCT positive group had higher duration of phototherapy (62.5±26.7 hours) as compared to the DCT negative group (46.1±23.5 hours) (p=0.002), longer hospital stay (5.9±3.5 days versus 4.8±1.8 days) (p=0.01), higher reticulocyte count (9.4±4.9% vs 5.7±2.5%) (p=0.001). Four babies in DCT positive group required exchange transfusion whereas none in the DCT negative group needed exchange transfusion (p=0.004), 10 (27.8%) needed IVIG in DCT positive group as compared to 3 (2.9%) in DCT negative group (p=0.0001) and neonatal intensive care unit (NICU) admissions were needed in 15 (41.7%) in DCT positive as compared to 8 (7.6%) in DCT negative group (p=0.0001).
Conclusion: A positive DCT at birth is associated with higher bilirubin levels and need for multiple interventions for jaundice management.
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