Direct coomb’s test in hyperbilirubinemia of the newborn

ORIGINAL ARTICLE

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.

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Abstract
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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