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Prevalence of rhesus type and ABO incompatibility in jaundiced neonates
Abstract
Objective: To determine the prevalence of Rh and ABO incompatibility in jaundiced neonates. Methodology: This hospital based descriptive study was conducted in Pediatrics Unit, Lady Reading Hospital Peshawar. A total of 200 neonates with clinically diagnosed jaundice were included in the study. Results: Out of 200 neonates 70% were male and 30%female. Majority of neonates 99.5% age was ranged from 0-10 days while only 0.5% neonate was 13 days. Out of 200 neonates, the frequency of ABO-incompatibility and Rh-incompatibility in jaundiced neonates in this study was 22.5% and 12.5% respectively. Out of the remaining 65.5% cases physiological jaundice was diagnosed in 40.5% neonates, prematurity in 15% neonates and G6PD in 9.5% neonates. Among 22.5% cases of ABO incompatibility there were 16.5% males and 6% females. Majority 15% presented on 1st day of life, followed by 3% on 2nd and 3rd day of life respectively, 1% on 4th day, 0.5% on 5th day of life. Conclusion: Out of 200 neonates presented with jaundice, prevalence of ABO-incompatibility was found to be 22.5% followed by Rh-incompatibility 12.5%.
... Irshad et al. (2011) observed the mean age to be 3.56 ± 2.56 days in newborns presenting to Lady Reading Hospital in Peshawar, Pakistan.17 Hassan et al. (2015) 18 reported an equivalent mean age of 5.4 ± 1.4 days in Iraq, whereas Honar et al. (2016) found an equivalent mean age of 3.71 days among Iranian similar infants. ...
... Irshad et al. (2011) observed the mean age to be 3.56 ± 2.56 days in newborns presenting to Lady Reading Hospital in Peshawar, Pakistan.17 Hassan et al. (2015) 18 reported an equivalent mean age of 5.4 ± 1.4 days in Iraq, whereas Honar et al. (2016) found an equivalent mean age of 3.71 days among Iranian similar infants. ...
2 House Officer, Rheumatology Ward, Shaikh Zayed Hospital, Lahore Pakistan Data Collection and Result Analysis ABSTRACT Background: The Jaundice, also known as hyperbilirubinemia, is a potentially fatal condition that affects neonates. Several different factors contribute to this complex illness. Objective: The objective of this study was to compare the mean duration of phototherapy in neonates with indirect hyperbilirubinemia treated with ursodeoxycholic acid plus phototherapy versus phototherapy alone. Study Design: Randomized Controlled Trial (RCT) study design. Settings: This study was carried at. Methods: Seventy full-term babies of both sexes were randomly split into two groups. Indirect hyperbilirubinemia was the diagnosis for all the infants, and phototherapy was being used to treat the condition. The patients in Group-A also received Ursodeoxycholic acid in addition to the phototherapy, while those in Group-B received only the phototherapy. Results: The average age of the newborns was 4.77 ± 3.05 days. There were a total of 50 newborns, 49 boys (or 70%) and 21 girls (or 30%). The indirect bilirubin levels of the newborns varied between 8.3 and 13.6 mg/dl, with a mean of 10.731.61 mg/dl. The survival rate of newborns treated with ursodeoxycholic acid and phototherapy was significantly higher than that of neonates treated with phototherapy alone (20.60 ± 4.24 vs. 43.34 ± 4.56 hours; p0.001). Conclusion: Due to its low cost, ease of administration, and better safety profile, the addition of ursodeoxycholic acid significantly decreased the mean duration of phototherapy in neonates presenting with jaundice, which supports the preferred use of this novel agent in the management of such neonates in future practice.
... Depending upon the cause, jaundice may be present at birth or any time during the neonatal period. Jaundice due to either indirect (unconjugated) or direct (conjugated) bilirubin within the first 24 hours of life should be taken seriously (1) . ...
... In contrast to our result, Abdelazeem et al. (8) reported that there was statistically significant difference regarding duration of phototherapy in the studied groups. This study showed that the mean of duration of phototherapy in group [1] was 2.5 ± 1.5 days while in group [2] it was found that the mean of the duration of phototherapy was 4.0 ± 1.4 days. ...
Background: Jaundice is the most common condition that requires medical attention in newborns. The yellow coloration of the skin and sclera in newborns with jaundice is the result of accumulation of unconjugated bilirubin. Objectives: To assess the efficacy of intensive phototherapy as a treatment modality for neonatal hyperbilirubinemia. Subjects and methods: This was A prospective, cohort, controlled study that was conducted on 100 babies with neonatal jaundice. They were admitted to Luxor General Hospital NICU at the beginning of November 2018 to the end of October 2019. Those 100 cases had been divided into 2 groups: the first group received intensive phototherapy sessions as a treatment modality for neonatal jaundice and the second group received conventional phototherapy. Results: The results of the study revealed that intensive phototherapy had succeeded in decreasing the need for exchange transfusion in 39 cases (78 %), whereas 11 cases (22%) remained for exchange transfusion (p value (0.001) was highly significant). Conclusion: The use of intensive phototherapy in the treatment of indirect pathological hyperbilirubinaemia is as effective as exchange transfusion in lowering total serum bilirubin when its level is within 2-3 mg/dl (34-51 µmol/l) of the exchange level and it is effective in reducing needs for exchange transfusion and duration of phototherapy.
... Screening for G6PD deficiency and recognition of prevalence of the enzyme deficiency in individual This study was conducted on 202 neonates with hyperbilirubinemia with mean age was 3.75 ± 2.5 days and 99% of cases presented in first 10 days of life. Irshad et al. found that mean age of neonates with hyperbilirubinemia was 3.56 ± 2.56 and 99.5% of cases presented between 0 and 10 days [8]. ...
... In the current study, male outnumbered female with male to female ratio was 2.5:1 that also observed in other studies [8,9] as males may be inherently more vulnerable to neonatal jaundice than females, but the reason for this gender differences remains to be elucidated [10]. ...
Background:
The enzyme, Glucose-6-phosphate dehydrogenase (G6PD), deficiency leads to impaired production of reduced glutathione and predisposes the red cells to be damaged by oxidative metabolites, causing hemolysis. Deficient neonates may manifest clinically as hyperbilirubinemia or even kernicterus.
Objective:
This study was carried out to detect erythrocyte G6PD deficiency in neonatal hyperbilirubinemia.
Methods and design:
To determine the frequency and effect of G6PD deficiency, this study was conducted on 202 neonates with indirect hyperbilirubinemia. All term and preterm babies up to 13 day of age admitted with clinically evident jaundice were taken for the study. G6PD activity is measured by the UV-Kinetic Method using cellular enzyme determination reagents by spectrophotometry according to manufacturer's instructions.
Results:
A total of 202 babies were enrolled in this study. Male babies outnumbered the female (71.3% versus 28.7%). Mean age of the study newborns was 3.75 ± 2.5 days. Eighteen neonates (8.9%) had G6PD deficiency, all are males. One case had combined G6PD deficiency and RH incompatibility. Mean serum total bilirubin was 17.2 ± 4.4 in G6PD deficient cases. There was significant positive correlation between the time of appearance of jaundice in days and G6PD levels in G6PD deficient cases.
Conclusion:
Neonatal hyperbilirubinemia is associated with various clinical comorbidities. G6PD deficiency is found to one important cause of neonatal jaundice developing on day 2 onwards.
... Our results are in line with the previously published local study by Irshad et al. who also observed similar age difference in the frequency of ABO and Rh incompatibility. 9 Thus in the present study majority of neonates had hemolytic jaundice with most of patients had ABO incompatibility. So in future practice special attention should be given to anticipate, timely recognize and treat these causes to decrease the morbidity and mortality associated with neonatal hyperbilirubinemia. ...
ABSTRACT
Objective: To find the frequency of different causes of unconjugated
hyperbilirubinemia in admitted term neonates.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted at the
neonatal ward of the Children’s Hospital and the Institute of Child
Health, Lahore from 20 August 2018 to 19 February 2019.
Material and Methods: The criteria of inclusion was neonates from
birth to twenty eight days of life having unconjugated
hyperbilirubinemia. Consent was taken and all the data was written on
pre designed proforma.
Results: A total of 200 patients were enrolled. There were 140 (70%)
male and 60 (30%) female neonates in the study group. The mean
serum bilirubin was 9.96 ± 2.47 mg/dl. Seventy seven (38.5%)
neonates had hemolytic jaundice, 26% had ABO incompatibility while
12.5% had Rh incompatibility. Twenty four (12%) had non-hemolytic
jaundice due to breast feeding while breast milk jaundice was
diagnosed in 99 (49.5%) neonates.
Conclusion: Most common cause was hemolytic jaundice among
neonates. By identifying different causes of neonatal
hyperbilirubinemia, we can reduce disease burden in our community
by formulating measures for their early detection, prevention and
management of severe neonatal jaundice.
Key Words: Unconjugated hyperbilirubinemia, Hemolytic jaundice,
Non-Hemolytic jaundice
... Depending upon the cause, jaundice may be present at birth or any time during the neonatal period. Jaundice due to either indirect (unconjugated) or direct (conjugated) bilirubin within the first 24 hours of life should be taken seriously (1) . Phototherapy has remained the standard of care for the treatment of hyperbilirubinemia in infants for four decades. ...
Background: Neonatal hyperbilirubinemia is the most common cause of admission in NICU. Phototherapy is the golden standerd therapy long time ago, which shows efficacy and safety but its side effects should be studied in depth. Both endotheline 1 (ET-1) and nitric Oxide (NO) are potent vasoconstrictor and vasodilator respectively and they are affected by phototherapy. Objectives: This study aimed to investigate the impact of phototherapy on the level of ET-1 and NO in fullterm and preterm as well as studying their effect on hemodynamic stability in treated newborns. Subjects and Methods: This study included 120 newborn infants who were classified into two groups. 60 patients (30 term infants and 30 preterm infants < 37 weeks and > 30 weeks) with unconjugated hyperbilirubinemia indicated for phototherapy and not indicated for exchange transfusion and the onset of jaundice from 2 nd to 4 th day. In addition, to 60 apparently healthy newborns as control group with matched age, sex, weight and gestational age. Results: There was significant increase in both endothelin-1 and nitric oxide in both fullterm and preterm groups after phototherapy. For fullterm and preterm groups, ET-1 levels significantly increased after 12 hour and 24 hour phototherapy (p-value = 0.048 and 0.013 respectively) for fullterm (p-value = 0.046 and 0.028 respectively) for preterm. Nitric oxide levels among fullterm and preterm groups significantly increased after 12 hour and 24 hour phototherapy (p-value = 0.042 and 0.012 respectively) for fullterm (p value =0.048 and 0.012 respectively) for preterm. The means heart rate changes among fullterm and preterm groups were significantly increased. However, mean arterial blood pressure among full term and preterm groups was significantly decrease after 24 hours of phototherapy. There was a positive correlation between serum levels of ET-1 and NO and heart rate after phototherapy among term and preterm neonats. A negative correlation was found between mean BP and serum levels of NO and a positive correlation between serum levels of ET-1 and mean BP after phototherapy among term and preterm neonates. Conclusion: There was significant increase in both endothelin-1 and nitric oxide in both fullterm and preterm groups after treatment with photo-therapy. In addition, a significant increase in mean heart rate and a significant decrease in mean blood pressure among preterm and fullterm groups befor and after phototherapy and before phototherapy versus controls.
... We observed that there was a slight male predominance among jaundiced neonates with male to female ratio of 1.4:1. Irshad et al. 14 In the present study, the mean weight of the jaundiced neonates was 2.89±0.49 Kg while the mean serum bilirubin level upon admission was 16.73±1.19 ...
Study Objectives: To compare the mean duration of phototherapy in neonates with hyperbilirubinemia receiving phototherapy with vs. without probiotics. Study Design and Settings: It was a randomized controlled trial carried at Department of Pediatrics, DHQ Hospital Kasur from Jan 2021 to June 2021. Patients and Methods: The present research involved 94 neonates of both genders aged between 2 to 28 days of life diagnosed of neonatal hyperbilirubinemia (serum bilirubin level ≥15mg/dL and direct bilirubin level ≤1.5 mg/dL). These neonates were allocated into two groups randomly. Neonates in Group-I were given probiotics along with conventional treatment of phototherapy whereas neonates in Group-II received conventional phototherapy alone. Study outcome was described in terms of mean duration of phototherapy (phototherapy was stopped when serum bilirubin level was less than 10 mg/dl during the first week and less than 11 mg/dl after the first week) which was recorded and compared between the groups. An informed written consent was taken from parents of every neonate. Results of the Study: The mean age of the neonates was 6.54±4.96 days while the mean gestational age was 37.31±2.04 weeks. There were 55 (58.5%) baby boys and 39 (41.5%) baby girls with a boys to girls ratio of 1.4:1. The mean weight of the neonates was 2.89±0.49 Kg while the mean serum bilirubin level upon admission was 16.73±1.19 mg/dl. The mean duration of phototherapy was significantly shorter in neonates receiving probiotics along with phototherapy as compared to phototherapy alone (3.13±0.92 vs. 3.81±1.12 days; p=0.002). Similar significant difference was observed across various subgroups based on age, gender, gestational age, weight and serum bilirubin level upon admission. Conclusion: Addition of probiotics to conventional practice of phototherapy alone in jaundiced neonates was found to hasten the recovery evident from significant reduction in the mean duration of phototherapy advocating its routine use in future practice. Keywords: Neonatal Hyperbilirubinemia, Phototherapy, Probiotics
... Ten neonates (20%) had anemia. The serum bilirubin was independent of the parity of the mother (p value 0.97) as similar to that of in studies by Shah A et al and Kalakheti et al [20][21] [22] . The hallmark of HDN due to ABO incompatibility is the presence of microspherocytes on the peripheral blood smear. ...
... It may cause elevated levels of bilirubin and anemia but less severe than Rh hemolytic disease. ABO incompatibility occurs when mother blood group O conceives fetus with blood group "A" or "B" is the most common cause for HDN among the ABO blood group system and the IgG antibody is responsible for this condition [6]. ...
... rubin and anemia but less severe than Rh hemolytic disease. ABO incompatibility occurs when mother blood group O conceives fetus with blood group "A" or "B" is the most common cause for HDN among ABO blood group system and IgG antibody is responsible for this condition [6]. ...
... Anti-D IgG is responsible for rhesus illness in the neonate as this antibody can cross placenta. Rhesus (Rh) incongruity develops between an Rh-negative mother (previously sensitized) and her Rh-positive fetus [5]. Many workers have suggested lately that the incidence of substantial neonatal jaundice has amplified. ...
This review article discussed on neonatal jaundice which is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels Other clinical features may include excess sleepiness or loss of appetite. Consequences may include seizures, cerebral palsy. It may happen due to physiologic or pathologic etiologies. The need for treatment relies on bilirubin levels, the age of the child, and the underlying cause treatment may include more frequent feeding, phototherapy, or exchange transfusions.
... Neonatal hyperbilirubinemia (NNH) presenting within the first 24 h of life is considered a serious complication, thus, early identification and prompt management are necessary to prevent serious neurological complications like kernicterus [1,2]. The various risk factors for the development of NNH are blood group incompatibility (ABO and/or Rh), glucose-6-phosphate dehydrogenase (G6PD) deficiency, gestational age of 35-36 weeks, previous sibling on phototherapy, cephalohematoma and inadequate breastfeeding along with excessive weight loss [3]. ...
Objective
To determine the indication, efficacy and adverse events related to exchange transfusion (ET) with reconstituted blood (RB) in neonatal hyperbilirubinemia (NNH).
Methods
Blood bank records of neonates who underwent double volume ET for NNH from January 2013 to July 2018 were retrospectively reviewed. Demographic details, cause of NNH, details of ET and ET related adverse events were recorded.
Results
A total of 23 ET (average: 1.64/neonate) were performed in 14 neonates (9 males; 5 females) with a mean age of 9.8 ± 7.6 days. Ten (71.4%) neonates underwent 1 session of ET, while 4 (28.6%) underwent repeated sessions (average: 3.25/neonate). A total of 5,912 ml of RB was transfused (average: 422 ml/neonate). A statistically significant reduction was noted in total serum bilirubin (TSB) level post-ET (p < 0.001) with overall TSB reduction/procedure being 46%.
Of the 14 neonates with NNH, 11 (78.6%) had Rh haemolytic disease of foetus and new-born (HDFN), 2 (14.3%) had ABO HDFN and 1 (7.1%) had hyperbilirubinemia due to prematurity. Of the 11 neonates with Rh HDFN, only 5 underwent intrauterine transfusion (average: 1.8/neonate).
Post-ET, top-up transfusions were noted in 8 (57.1%) neonates with packed red blood cell and/or platelet concentrate. ET related adverse were noted in 5 (21.7%) procedures only.
Conclusion
Rh HDFN was the most common cause of NNH in our study population.Exchange transfusion is a safe treatment modality for treating NNH, as it results in the rapid elimination of serum bilirubin, thus, lowering the risk of kernicterus in these patients.
... The ABO blood group incompatibility that is the most common type, 2. Rh system incompatibility that is the most severe type, 3. Incompatibility of other blood group systems such as Kidd, Duffy, Kell, etc. (7)(8)(9). HDN caused by ABO incompatibility is often not severe because of three reasons: 1) Blood group antigens are not well developed early after birth, 2) The amount of these antigens is low during the fetal period, and 3) The antibodies against ABO antigens are often immunoglobulin M (IgM) which cannot pass the placenta (10,11). HDN caused by ABO incompatibility is the leading cause of neonatal jaundice which may generate serious problems in the fetus or the newborn. ...
... A study demonstrated that, in ABO incompatible neonates especially neonates of A blood group born to O positive mother becomes more incompatible and hemolyzed. Highly morbidity and mortality rate reported in our data suggest early transfusion of ABO-specific red blood cells in neonates of less than 4 months to deal with incompatibility [16][17][18]. About 55% of the subjects have been reported to be simultaneously suffering from other disease infections during the progression of biliary atresia while 45% neonates only had the problem of prolonged jaundice during that tenure. ...
Biliary atresia often neglected as normal transition neonatal jaundice reports high incidence in Pakistan in contrast
to worldwide statistics. In contrast to data reported worldwide high mortality and morbidity rate of Biliary Atresia
was reported within the Faisalabad region of Pakistan which indicates poor disease management. To understand the
exact etiology of this disease, present study undertook a research initiative to define unique causes and clinical risk
factors associated to Biliary atresia which help in early diagnosis. We intended to find strongly associated risk factors
which distinguish it from early onset normal transition jaundice and suggest good prognostic measures for disease
management. Logistic Regression and Pearson chi square test reports high incidence rate of Biliary atresia in newly
born baby boys (64%) than in female peers. Only 27% of survival rate of this disease was recorded. Unique association
of disease with mother child blood group incompatibility (P
... Majority 15% presented on 1st day of life followed by 3% on 2 nd and 3rd day of life respectively, 1% on 4th day and 0.5% on 5th day of life. 18 Association of ABO and Rh incompatibility with neonatal hyperbilirubinaemia was researched by Apexa S Patel et al. The incidence of ABO incompatibility was 13.79% and of Rh incompatibility was 1.37%. ...
... In our study it was obvious that the most common cause for jaundice was ABO incompatibility in both groups of newborns who received pre-discharge phototherapy in the nursery or babies who were readmitted for management of indirect hyperbilirubinemia during the two periods (31.7% and 36.4% respectively). Our results were higher compared to the study conducted in pediatric unit, Lady Reading Hospital, Peshawar where out of 200 neonates presented with clinical jaundice, prevalence of ABO incompatibility was found to be 22.5% [27]. But it was similar to a study in Sgro in Canada, where ABO incompatibility was most common cause in newborns admitted for severe hyperbilirubinemia [28]. ...
... In the indirect hyperbilirubinemia group, one neonate presented with Rh hemolytic disease of the newborn (a frequency of 2.6% in the indirect hyperbilirubinemia group and 0.4% of all neonates). This finding is in agreement with previous studies, which state that Rh hemolytic disease of the newborn is less common than previously owing to the administration of Rh Ig, which results in a greater than 90% reduction in the alloimmunization rate among treated women 41,45 . ...
The aims of this study were to detect the frequency at which the different types of neonatal jaundice occur in Makkah and to estimate the malondialdehyde (MDA) levels. This study included 239 neonates with neonatal jaundice, 20 anemic neonates and 21 healthy neonates. ABO incompatibility was observed in 31.6% of neonates with indirect hyperbilirubinemia, in 14.3% of those with early onset jaundice, in 9.5% of those with persistent jaundice, in 8.5% of those with physiological jaundice, in 5% of anemic neonates and in 12% of all neonates. glucose-6-phosphate dehydrogenase (G6PD) deficiency was observed in 10.5% of neonates with indirect hyperbilirubinemia, in 3.9% of those with physiological jaundice, in 11.1% of those with direct hyperbilirubinemia, in 12% of those with persistent jaundice, in 10% of anemic neonates and in 6.6% of all neonates. Rh incompatibility and polycythemia were found in 2.6% of neonates with indirect hyperbilirubinemia and in 0.4% of all neonates. In comparison to control group, MDA was significantly higher in all groups except for the anemic group. In conclusion, ABO incompatibility and G6PD deficiency frequently result in neonatal jaundice in Makkah, whereas Rh incompatibility and polycythemia are rare. The MDA level may serve as an indicator of oxidative stress.
Introducción. La ictericia neonatal una enfermedad habitual en las unidades de salud, el 60% de neonatos sanos muestran hiperbilirrubinemia en la primera semana de vida, sabiendo que la comorbilidad incrementa el riesgo de un desarrollo neurológico, es importante conocer sobre las causas para prevenir secuelas a futuro. Objetivo. Caracterizar la ictericia neonatal e hiperbilirrubinemia y relacionar factores neonatales maternos con variables clínicas. Metodología. El estudio es descriptivo, retrospectivo, de corte transversal, se centra en los recién nacidos vivos del Hospital Moreno Vázquez, Ecuador, de enero a diciembre de 2021-2022. Resultados. A partir de 296 recién nacidos ingresados en la unidad de pediatría, 205 neonatos fueron diagnosticados por ictericia neonatal o hiperbilirrubinemia, encontrándose una prevalencia del 69%, como etiología de esta patología se evidencia hiperbilirrubinemia fisiológica 69,26%, reportándose un promedio de bilirrubina total de 11-15 mg/dl. Entre los neonatos con hiperbilirrubinemia existió un leve predominio del sexo masculino (50,7%; n=105); sin embargo, el segundo diagnóstico más frecuente durante el tiempo de hospitalización fue la incompatibilidad ABO (30,73%; n=63), en los factores asociados la edad neonatal destaca los 5 primeros días como los principales para detección de hiperbilirrubinemia. Conclusión. La incidencia de ictericia e hiperbilirrubinemia neonatal fue del 69% de predominio fisiológico, la relacion entre las variables clínicas se demostró como factor de riesgo a la edad extrauterina de 5,41 días.
Background: Neonatal jaundice is a common condition in the early days ofinfant’s life. It clinically manifests in a significant number of full term babies and almost allpremature neonates. Increase in the serum bilirubin during early infancy is multi factorial andmay result in kernicterus. Deposition of unconjugated bilirubin in the brain stem nuclei andbasal ganglion results in permanent brain damage. Objective: To determine the frequencyof common hemolytic causes of hyperbilirubinemia in full term neonates requiring exchangetransfusion. Study Design: Cross-sectional study. Setting: Department of Pediatrics, LadyReading Hospital Peshawar. Period: January to June 2015. Methodology: A total of 449 fullterm neonates requiring exchange transfusion were included in this study on the basis of serumbilirubin level (total, direct, indirect). Hemolytic causes were analyzed by checking blood groups,rhesus factors and measuring glucose 6 phosphate dehydrogenase (G6PD) levels. Results: Inthis study mean age was 10 days with standard deviation ± 1.26. Sixty two percent neonateswere male and 38% were female. Hemolytic causes were analyzed and ABO incompatibilitywas found in 25% neonates, rhesus incompatibility in 15% neonates and G6PD deficiency in32% neonates. Conclusion: In this study, the most common cause of severe jaundice requiringexchange transfusion was G6PD deficiency (33%) with hemolysis.
Background: Better understanding of the clinical characteristics of HDN due to ABO incompatibility helps to optimise care. The objective of this study was to investigate the clinical manifestations and outcome of treatment modalities.Methods:This study was a hospital based cross sectional study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute. A total of 50 neonates with blood group A or B born to mothers with blood group O; with jaundice and or anemia were enrolled during the period from January 2015 to December 2015. The various maternal and neonatal parameter and their association with development of jaundice and or anemia was studied. The outcome of treatment modalities was studied.Results: Out of 50 ABO Incompatible neonates 24 (48%) were male and 26 (52%) were female. The percentage of O–A and O–B incompatible neonates were 38% (19) and 72% (31), respectively. Jaundice was detected within the first 24 hours in 6% and 18% neonates had anemia. The mean age of presentation was 2.9±0.89 days. The various maternal and neonatal factors had no significant association with development of jaundice and or anemia due to ABO Incompatibility. The mean initial Indirect Bilirubin was 21.26±3.97, initial hemoglobin was 14.3±2.31 and the mean Reticulocyte count was 16.6±5.3. Total 22 (44%) neonates had laboratory evidence of hemolysis (microspherocytosis). DCT was positive in 4 (8%) neonates. The main clinical manifestation was jaundice and was treated with phototherapy in 49 (98%) of the cases. The mean duration of phototherapy was 53.84±9.82 hours. Only one infant required exchange transfusion and on follow up had no neurological sequelae. The mean total duration of stay was 3.6±1.2 days. There was no significant difference in the HDN due to either O–A or O–B incompatibility.Conclusions:Early identification of high risk neonates with ABO Incompatibility, diagnosis and early intervention can reduce morbidity and mortality.
Background information: Neonatal jaundice is a very common condition worldwide, occurring in up to 60% of term and 80% of preterm new born in the first week of life. The incidence, aetiological and contributory factors to neonatal jaundice differs in ethnicity and geographical distribution. In Nigeria, it accounts for between 23% and 60% of admission into the Special Care Baby Unit (SCBU), and various factors are responsible for its occurrence. The aim of the study was to assess the frequency , determinants, prevalence and predictors of Neonatal jaundice among in-born neonates and out-born neonates managed in Niger Delta University Teaching Hospital(NDUTH), Okolobiri, Bayelsa State
Material and Method: A retrospective descriptive study of Case file of all in-born and out-born neonates admitted in Special Care for neonatal jaundice from January 2010 to December, 2012 were included. Information from case file of the index cases were collected using a proforma of data collection sheet within a ten week period. Socio-demographic characteristics, associated risk factors, prevalence rate for each year, survival rate, treatment modalities and out-come were determined. The data was organized, validated, and analysed using SPSS. Quantitative variables were summarized using range, mean, and standard deviation. Categorical variables were tabulated using frequencies and percentages. Chi-square test were used for testing the significance of association between categorical variables. Student’s t- test was used to compare two means. Survival rate of treatment modalities determined.
Result: A total of 664 neonates were admitted into the special care baby unit of the Pediatrics department, NDUTH. 199 (17.9%) of the neonates were diagnosed with neonatal jaundice(NNJ). Majority of which were aged between 1-2 days making about 82 (41.2%) of the neonates with NNJ.The males, were most commonly affected 121 (60.8%) compared to females 78 (39.2%). Maternal age with the highest cases of children with NNJ was between 26-30 years, 59 (29.6%). Majority of the women had secondary level of education, 121 (60.8%).The prevalence rate were 240, 227), 300 per 1000 neonates admitted in the hospital for 2010.2011 and 2012 respectively. The identifiable risk factors in this study were preterm’s 81(40.7%), low birth weights 105(52.8%), poor maternal booking status, neonatal sepsis 119(59.8%) and birth asphyxia (low APGAR score).The use of more than one treatment modality improve survival rate of neonates with Jaundice. Phototherapy is the most important option that must be used in the management of Neonatal Jaundice.
Conclusion: Neonatal jaundice remains high among cases admitted into the special care baby unit in developing nations. Therefore antenatal and neonatal care should be improved and supported by all health care stakeholders if childhood millennium development goals would be achieved.
distribution in Arains was: A 25.6%, B 40.5%, AB 9.2%, O 24.7%. Awans: A 22%, B 31.7%, AB 9.9%, O 36.5%. Rajputs: A 23%, B 33.2%, AB 8.8%, O 35.1%. Misc Punjabi sub casts: A 23.6%, B 33.2%, AB 7.5%, O 35.7%. Balochs: A 23.3%, B 27.9%, AB 7.8%, O 40.9%. Sindhis: A 24.9%, B31.8%, AB 6.9%, O 36.5%. Kashmiris: A 23.7%, B 32.5%, AB 10.2%, O 33.6 %. Pathans: A 24.3%, B 31.4%, AB 8.9%, O 35.4%. Rh- D negative (n=749) blood group in Araeens 8.3%, Awans 10.4%, Rajputs 8.5%, Misc Punjabi sub casts 8.8%, Balochs 7.8%, Sindhis 8.7%, Kashmiris 10.9% and Pathans 7.7%. Conclusion: There is no statistically significant difference of ABO and Rh-D distribution among various ethnic groups, O is the most common blood group except in Arains where B is the most common and O is less common.
Neonatal jaundice is the result of an imbalance between bilirubin production and elimination. Bilirubin conjugation in newborns is significantly impaired in the first few days; even a small increase in the rate of production can contribute to the development of hyperbilirubinemia. Hemolysis has a significant role in bilirubin increase in newborns. Intrauterine is tolerated by the maternal metabolism in life. When hemolysis takes place, a decrease is accepted in the haptoglobin and hemopoexin blood levels binding hemoglobin in the environment. Therefore, it may be considered that haptoglobin and hemopoexin from the early period umbilical cord (UC) blood in newborns may be an indicator in determining jaundice likely to develop in later stages. Babies were called to the control polyclinic in the third and fifth days. Eighty-four babies with normal term birth were included in the study. Gestational age of the mothers was 39.5+/-1.5 weeks in average. A significant negative correlation was found between the haptoglobin level from the UC taken during delivery and the bilirubin value in the fifth day (r=-0.345; P=0.001). The haptoglobin value from the blood of the UC can be used as a guiding indicator to demonstrate the future occurrence of jaundice in newborns. This way, the babies with high jaundice risk may be detected earlier and closer follow-up of these babies can be obtained. As a result, the haptoglobin level of the blood from the UC during delivery allows us to make an early prediction on whether neonatal jaundice will occur.
Maternal-fetal ABO incompatibility is a common hematological problem affecting the newborn. In general, hemolysis is minimal and the clinical course is relatively benign, rarely causing the escalating levels of hyperbilirubinemia and significant anemia commonly associated with Rh hemolytic disease of the newborn (HDN). The incidence of HDN ranges from one in 150 births to 1:3000 births, depending on the degree of anemia and level of serum bilirubin. The etiology of ABO hemolytic disease of the newborn (ABO-HDN) is complex because anti-A and anti-B antibodies are composed mainly of IgM. Since only IgG antibodies cross the placenta, those pregnant women with high levels of IgG anti-A,B, anti-A, or anti-B with an ABO incompatible fetus will be the ones to give birth to an infant with ABO-HDN. We describe a case of a B/Rh positive term newborn born to an O/Rh negative African-American mother demonstrating aggressive hemolysis and a robust response of the bone marrow. This case was successfully managed with phototherapy and simple RBC transfusion without the need for exchange transfusion.
Up till now about 400 red cells antigen have been identified. The majority are inherited by Mendelian Fashion. The ABO blood group system was first to be identified and RH blood group system was the 4th one, both are most important for blood transfusion purposes. This study is conducted to determine the frequency of ABO and Rhesus (Rh) blood groups in District Swat, NWFP, Pakistan. It is a cross sectional prospective study and was conducted at Saidu Teaching Hospital district Swat, over a period of one year. (1st Jan. 2007 to 31st Dec, 2007).
A total of 22897 subjects were included in this study. Patients were collected from different wards of Saidu Teaching Hospital while the donors from common population. From each subject blood was collected, ABO and Rh blood grouping were carried out by tile method using commercially prepared anti sera. The frequency of each type was calculated.
Out of 22897 subjects 17141 (74.86%) were male subjects and 5756 (25.140%) were female. Out of 17141 male subjects 15597 (90.99%) and out of 5756 female subjects 5040 (87.56%) were found to be Rh-positive. The frequency of Rh-negative group in male subjects were (9.01%) where as in female subjects were (12.22%). The frequency of A, B, O and AB groups in Rh-positive male subjects were 25.63%, 29.54%, 26.04% and 9.78%, amongst female subjects, it was 24.53%, 28.06%, 25.54% and 9.43% respectively. In Rh-negative male subjects the frequency of A, B, O and AB is 2.25%, 2.88%, 3.01% and 0.88%, while amongst females it is 3.54%, 4.24%, 3.74% and 0.92% respectively.
It is concluded from this study that frequency of Rh-positive blood group is B, O, A, and AB in both gender. Where as the most common Rh-negative in male and female subjects are O, B, A, AB, and B, O, A, and AB respectively.
Neonatal Jaundice (NNJ) is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it.
To determine the knowledge of the women attending Children Outpatient (CHOP) and Immunization clinics on the causes, treatment and complications of neonatal jaundice.
Women who brought their children/wards to the immunization/children out patient clinics at the University of Port Harcourt Teaching Hospital Port Harcourt were interviewed using structured questionaire.
There were 255 mothers who participated in the study. Of these 30 (11.8%) have never heard of neonatal jaundice while 225 (88.2%) have heard and only those who have heard were further analyzed. The age range was from 16 to 47 yrs (mean age 27.1 +/- 3.3 years). Median parity was 2. One hundred and twenty two (54.2%) women had tertiary education. One hundred and seventy four (77.3%) correctly defined neonatal jaundice, and in 114 (44.7%) source of information was from health talk in the clinic. Seventy five (33.3%), and 50 (22.2%) erroneously believed that eating too much groundnut in pregnancy and mosquito bite respectively were the main causes while 55 (24.4%) correctly answered that it is due to mismatch of mother and baby's blood. Only a few knew that use of dusting powder on baby's cord, prematurity, and storing baby's clothes in camphor were risk factors for NNJ. One hundred and fourteen (50.7%) and 60 (26.7%), wrongly believed that exposure to sunlight and use of glucose drinks respectively were the main forms of treatment and 50 (22.2%) knew brain damage as a possible complication
There is still misconception on the causes and risk factors and treatment of neonatal jaundice among our women. Also only a few women are reached by the health talk in the clinics. There is therefore urgent need for massive health enlightenment campaign.
The analysis of a sample of 1632 individuals from patients of the Nishtar Teaching Hospital, Multan, suggests that different ethnic groups (Araeen, Mughals, Syed, Jat, Rajputs, Baloch and Pathan) are not significantly different from another with regard to the distribution of RH blood group alleles (RH*d around 0.30). The distributions of the AB0 blood group alleles suggest that different ethnic groups are not significantly different from the average alele frequencies (AB0*A = 0.23, AB0*B = 0.33, AB0*0 = 0.47) except for the Pathan ethnic group (AB0*A = 0.35, AB0*B = 0.47, AB0*0 = 0.27). The populations of different geographic areas are not significantly different from the average allele frequencies, except for the southern district of Rahim Yar Khan (AB0*A = 0.12) and the northern district of Sahiwal (AB0*A = 0.19). The populations of Sahiwal (RH*d = 0.35) and Muzaffargarh (RH*d = 0.36) yield significantly different allele frequencies at the RH locus. The interpopulation differences can be explained by the geographic distance. There is a significant difference in the frequencies of the AB0 alleles between rural and urban populations, suggesting that rural populations maintain their isolation from urban populations. Rural and urban populations are not significantly different from one another concerning the allele frequencies at the RH locus.
The frequencies of ABO and Rhesus D blood groups vary from one population to another.
To determine the frequencies of the ABO and Rhesus D blood groups and to assess the preparedness of the hospital based patient targeted blood donor unit in the provision of blood and blood products and also to determine the blood groups of patients attending the antenatal clinic over the same period.
A retrospective study using data from the hospital's blood transfusion unit.
The Aga Khan Hospital, Nairobi.
All persons donating blood and attending the antenatal clinic between October 1997 and December 1997 were included in the study.
Blood group O was found to be most frequent: 49% in indigenous African donors and ANC attendants, 45% in the general donor population and 34% among Asian donors. The frequency of blood group B was 33% in the Asian donors, 27% in all donors, 25% in African donors, and 24% in ANC attendants. Group AB was seven per cent in Asian donors, five per cent in both the general donor population and the ANC attendants and four per cent in the African donors. The frequency of blood group A was 26% in Asian donors, 23% in all donors and 22% in both the African donors and ANC attendants. Ninety four per cent of the indigenous African donors were Rhesus D positive, 97% of the ANC attendants were Rhesus D positive and 90% of the Asian donors were Rhesus D positive.
The blood groups of blood and blood products available at the hospital based transfusion unit closely correlate with those of the general population. A positive bias towards the rarer blood groups AB and Rh D negative is noted. The Rhesus D antigen has a high prevalence in indigenous Africans.
The frequencies of ABO and rhesus blood groups vary from one population to another. We studied blood group distribution in 120 Nepalese students; 34% were blood group A, 29% group B, 4% group AB and 32.5% group O. The frequency of Rh-negative blood was 3.33% and Rh-positive 96.66%.
Because there is some in vivo and in vitro evidence that standard phototherapy might produce hemolysis, we wished to know whether intensive phototherapy produces hemolysis.
We measured end-tidal carbon monoxide (CO) concentration corrected for ambient CO (ETCOc) in 27 newborn infants > or =35 weeks gestation receiving intensive phototherapy (average irradiance 43 microW/cm2/nm).
There was a steady decrease in the mean ETCOc over the course of the phototherapy.
Intensive phototherapy did not produce hemolysis in infants > or =35 weeks gestation.
Newborns with jaundice or unrecognized hyperbilirubinemia are a vulnerable population which is likely to be deprived from preventive and/or therapeutic healthcare services in their transition from birthing hospital to their homes. Of the 4 million infants born each year in the United States over 3.5 million are born at 35 or more weeks of gestation. Most have benign outcomes with little or no threat of neurological compromise from medical conditions during their first year of life. Over the past 4 decades proven preventive health measures provided at well-baby nurseries and at delivery rooms have been effective in reducing infant mortality and morbidity. However nearly all healthy infants have some degree of hyperbilirubinemia and over 60% develop jaundice during their first week of life. When unmonitored or untreated in a timely manner hyperbilirubinemia can become excessive and may be unrecognized if the infant is not under medical supervision. An adverse outcome could be a spectrum of bilirubin-induced neurologic dysfunction (BIND) and its severest manifestation: kernicterus a lifelong athetoid cerebral palsy with sensorineural auditory impairment. (excerpt)
Kernicterus and neurologic sequelae caused by severe neonatal hyperbilirubinemia are preventable conditions. A structured and practical approach to the identification and care of infants with jaundice can facilitate prevention, thus decreasing rates of morbidity and mortality. Primary prevention includes ensuring adequate feeding, with breastfed infants having eight to 12 feedings per 24 hours. Secondary prevention is achieved by vigilant monitoring of neonatal jaundice, identifying infants at risk of severe hyperbilirubinemia, and ensuring timely outpatient follow-up within 24 to 72 hours of discharge. Total serum bilirubin or transcutaneous bilirubin levels should be routinely monitored in all newborns, and these measurements must be plotted on a nomogram according to the infant's age in hours. The resultant low-, intermediate-, or high-risk zones, in addition to the infant's risk factors, can guide timing of postdischarge follow-up. Another nomogram that consists of age in hours, risk factors, and total bilirubin levels can provide guidance on when to initiate phototherapy. If the infant requires phototherapy or if the bilirubin level is increasing rapidly, further work-up is indicated.