A comparative study of peak total serum bilirubin level in neonates with ABO incompatibility, Rh incompatibility and G6PD deficiency.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 10
Abstract
Introduction: Maternal-fetal ABO blood group incompatibility, in which the mother has blood group O and the newborn has blood group A or B, occurs in 15-20% of all pregnancies. The hemolytic process results from maternal anti-A or anti-B immunoglobulin G (IgG) antibodies crossing the placenta and attaching to the appropriate antigens on the neonatal red cells. Rh incompatibility develops when an Rh negative mother has a baby with an Rh positive father. It is characterized by the presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia. Glucose-6- PhosphateDehydrogenase(G6PD) deficiency is an inherited deficiencythat may cause neonatal jaundice, as has been found in several countries and different ethnic groups. G6PD isan enzyme essential for basic cellular functions including protection of red cell proteins from oxidative damage. G6PD deficiency is the most common red cell enzyme abnormality associated with hemolysis as well as withneonatal jaundice and also associated with kernicterus and even death. It is a genetically inherited sex-linkedabnormality. Methods: The study was done on 1619 clinically icteric babies without other risk factors forneonatal jaundice sepsis, prematurity, low birth weight, polycythemia, cephalhematoma,infant of diabetic mother and gastrointestinal obstruction etc., admitted in Neonatal Intensive Care Unit of GMCH, Guwahati over a period of 1 year.Investigations included direct and indirect serum bilirubin levels, blood group of mother and baby, directcoomb’s test, haemoglobin, blood smear examination, reticulocyte count, and G6PD status. Data was collectedand adequate intervention was done depending on indication. Data was analysed by software SPSS version 20. Results-In the neonates with ABO incompatibility (272), mean peak TSB level was 20.5±4.6mg/dl., In the neonates with Rh incompatibility (158), peak TSB was21.9±6.5mg/dl. In G6PD deficient neonates (146), mean peak TSB level was 23.9 ± 4.1 mg/dl. The P-value calculated is < 0.0001 which is extremely significant. Conclusions: The prevalence of severe NHB with ABO incompatibility, Rh incompatibility and G6PD deficiency among neonates in North East region ishigh and babies with these factors have higher chances of severe hyperbilirubinemia anddeveloping complications like kernicterus and poor neurodevelopmental outcome. Therefore, screening ofnewbornsfor ABO incompatibility, Rh incompatibility and G6PD deficiency is needed to be done in all newborns, so that these babies can be identified andadequate intervention can be donetimely
Authors and Affiliations
Dr. Mrinalini Das, Dr. Ashok Singh
Keywords
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