Reticulocytosis: the unevaluated parameter in neonatal jaundice requiring phototherapy


  • Rose Xavier Department of Pediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala
  • Manoj V. C. Department of Pediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala
  • Sanjeev Kumar T. M. Department of Pediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala
  • Vinod J. Cherian Department of Pediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala



Irregular antibodies, Neonatal jaundice, Phototherapy, Reticulocytosis


Background:Majority of the jaundiced neonates requiring phototherapy do not have an identifiable cause for the jaundice. Reticulocyte count more than 4% on day 3 of life is called reticulocytosis in neonates. So far no studies have evaluated the prevalence of reticulocytosis among jaundiced neonates requiring phototherapy.  Objective of the study was to identify babies with only reticulocytosis as cause for jaundice and identify factors contributing to reticulocytosis.

Methods: An observational study was carried out over a period of one year in the neonatal unit of a tertiary care hospital on 200 jaundiced neonates requiring phototherapy for determining the incidence of jaundice with unknown etiology. This data was analysed for prevalence of reticulocytosis and its contributing factors.

Results:67 of 200 babies with jaundice had reticulocytosis. An etiology for the reticulocytosis was found in 37 babies. 12 of the remaining 30 babies had dehydration (weight loss more than 10%) contributing to jaundice. 18 babies had no identifiable cause for the reticulocytosis. Mildly significant correlation was found with sibling history of neonatal jaundice (p = 0.052). No significant correlation was found with any other contributing factors.

Conclusions:Reticulocyte count should be done for any baby with jaundice requiring phototherapy. Screening for irregular antibodies and genetic studies need to be promoted along with routine tests, to identify the cause for reticulocytosis after working out the costs involved. 


Ambalavanan N, Carlo WA. Jaundice and hyperbilirubinemia in the newborn. Eds: Kleigman RM, Schor NF, Geme JWS, Behrman RE, Stanton BF. Nelson textbook of Pediatrics. 20th edition. Philadelphia Mosby: Elsevier; 2016:870-875.

Sgro M, Campbell D, Shah V. Incidence and cause of sever hyperbilirubinemia in Canada. Canadian Med Asso J. 2006;175(6):587-90.

Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. Initial clinical testing evaluation and risk assessment for universal screening for hyperbilirubinemia. study group. predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr. 2013;162:477-82.

Dana CM, Bertil G. Erythrocyte disorders in infancy. Avery’s diseases of the newborn. 9th edition. Saunders. 2012;1083-1084.

Kevin NI. Neonatal jaundice. Rennie and Robertson’s textbook of neonatology. 5th edition. Churchill Livingstone. 2012;682.

Maisels MJ. What’s in a name? physiological and pathological jaundice: The conudrum of defining normal bilirubin levels in the newborn. Pediatrics. 2006;118:805-7.

Suresh KP, Chandrasekhar S. Sample size estimation and power analysis for clinical research studies. J Human Reprod Sci. 2012;5(1):7-13.

Ronald SC, Ronald JW, David KS. Understanding neonatal jaundice: a perspective on causation. Pediatr Neonatol. 2010;51(3):143-8.

Robert DC, Hassan MY, Richard SL. neonatal hemolytic jaundice: morphologic features of erythrocytes that will help you diagnose the underlying condition. Neonatology. 2014;105:243-9.

Bhutani VK, Stevenson DK. The need for technologies to prevent bilirubin-induced neurologic dysfunction syndrome. Semin Perinatol. 2011;35:97-100.

Christensen RD, Lambert DK, Henry E, Eggert LD, Yaish HM, Reading NS, Prchal JT. Unexplained extreme hyperbilirubinemia among neonates in a multihospital healthcare system. Blood Cells Mol Dis. 2013;50:105-9.

Chen C, Hsu M, Shen C, Wang C, Chang S, Wu K et al. Influence of breast feeding on weight loss, jaundice and weight elimination in neonates. Paediatr Neonatol. 2011;52:85-92.

Xavier R, Manoj VC, Cherian VJ. Breastfeeding jaundice: how big is the problem? Int J Contemp Pediatr. 2016;3(2):498-503.

Jon FW, Zhili L. Exploring the genetic architecture of neonatal hyperbilirubinemia. Fetal Neonatal Med. 2010;15(3):169-75.

Boskabadi H, Maamouri GH, Mafinejad S. Prevalence and clinical manifestation of glucose-6-phosphate dehydrogenase deficiency in newborns with hyperbilirubinemia in Mashhad, Iran. Maced J Med Sci. 2011;4(1):93-8.

Wen SC, Wen YC, Hao YW. Etiological analyses of marked neonatal hyperbilirubinemia in a single institution in Taiwan. Chang Gung Med J. 2012;35:148-54.

Bhutani VK. For a safer outcome with newborn jaundice. Indian Pediatr. 2004;41(4):321-6.

Thakral B, Agrawal SK, Dhawan HK, Saluja K, Dutta S, Marwaha N. First report from India of haemolytic disease of the newborn by anti c and anti E in Rh (D) positive mothers. Haematology. 2007;12:377-80.

Wu KH, Chu SL, Chang JG, Shih MC, Peng CT. Haemolytic disease of the newborn due to maternal irregular antibodies in the Chinese population in Taiwan. Transf Med. 2003;13:311-4.

Christensen RD, Nussenzveig RH, Yaish HM, Henry E, Eggert LD, Agarwal AM. Identifying causes of significant hyperbilirubinemia in neonates using ‘next generation’ gene sequencing. J Perinatol. 2014;34:616-9.

Bryon JL, Nancy DS. Hyperbilirubinemia in the Newborn. Pediatrics. 2011;32:341.

Koelewijn JM, Vrijkotte TG, Schoot CE, Bonsel GJ, de Haas M. Effect of screening of red cell antibodies, other than anti D to detect hemolytic disease of the foetus and newborn: a population study in the Netherlands. Transfusion. 2008;48:941-52.

Sabita B, Ravneet K, Gagandeep K. Hemolytic disease of the fetus and newborn: current trends and perspectives. Asian J Transfus Sci. 2011;5(1):3-7.






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