Risk Assessment For Readmission For Phototherapy in Neonates With ABO Hemolytic Disease

Background: ABO hemolytic disease of the newborn (ABO HDN) is a main risk factor for neonatal hyperbilirubinemia, which is one of the most common causes for readmission in neonates after discharge. Our objective is to assess the risk factors for readmission in neonates with ABO hemolytic disease for phototherapy.Methords: 291 neonates at gestational age ≥ 35 weeks were enrolled with the diagnosis of ABO hemolytic disease by collecting their clinical and laboratory data retrospectively. All these infants were born in Women’s Hospital School of Medicine Zhejiang University between 2018 and 2019. . Among these neonates, 36 cases were readmitted due to hyperbilirubinemia, which is defined as the study group, while the other 255 cases as the control group.Results: The study and control groups were similar on maternal and infants basic parameters (P> 0.05), as well as the complications of both infants and mothers (P> 0.05). However, we found significant differences in the concentration of initial total serum bilirubin, the onset age for phototherapy, the positive direct antiglobulin test (DAT) between two groups (P <0.05). Logistic regression analysis suggested that the age for onset phototherapy and the initial level of total serum bilirubinwere both independent risk factors for readmission in neonates with ABO hemolytic disease.Conclusions: For neonates with hyperbilirubinemia due to ABO HDN, positive direct antiglobulin test (DAT), small age for phototherapy and high initial level of bilirubin can increase the risk of readmission for phototherapy.

Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study

Objective To evaluate the efficacy and safety of intravenous immunoglobulin G (IVIG) in infants with ABO hemolytic disease of the newborn (HDN). Methods Infants with moderate-to-severe ABO HDN during early neonatal period (<7 days) at our hospital in 2017 were included in this retrospective study. Patients treated with IVIG and phototherapy were classified as the IVIG group, and those who only received phototherapy were classified as the phototherapy only group. Results Forty-six patients were classified into the IVIG group and 68 other patients were classified into the phototherapy only group. There was no significant difference in duration of phototherapy, hospitalization periods, needs for exchange transfusion, transfusions, and incidence of bilirubin-induced neurological sequelae between these two groups (P = 0.20, 0.27, 0.65, 0.47, 0.78, respectively). Conclusion It seems unnecessary to expose neonates to IVIG in moderate-to-severe ABO HDN when the available data show no appreciable benefits.

Evaluation of endothelial microparticles as a prognostic marker in hemolytic disease of the newborn in China

Objective This study aimed to evaluate endothelial microparticles (EMPs) as a potential prognostic marker in hemolytic disease of the Chinese neonate. Methods We compared 29 newborns with ABO hemolytic disease of the newborn (ABO HDN), 22 newborns with Rh HDN, and 21 healthy newborns with matched mother and infant blood groups (controls). Markers of hemolysis and von Willebrand factor antigen (vWF Ag) were analyzed. EMP (CD144+) levels were measured before and after therapy. Results vWF Ag and pretherapy EMP levels were higher in the ABO HDN and Rh HDN groups than in the control group. Additionally, vWF Ag and pretherapy EMP levels were significantly higher in the ABO HDN group than in the Rh HDN group. Posttherapy EMP levels were decreased compared with pretherapy levels in the ABO HDN and Rh HDN groups. Moreover, hemoglobin and indirect bilirubin levels were independently correlated with pretherapy EMP levels in the ABO HDN group. Conclusion Our findings indicate that EMP measurement in neonates with HDN may provide a novel method of monitoring possible severe vascular dysfunction in patients in China. An external validation in larger datasets is necessary for further study.