Published: 2020-09-21

Outcome of neonatal jaundice in term neonates with ABO incompatibility at tertiary level center

Amit Kumar Thakur, Mohammad Ashfaque Ansari, Atindra Mishra, Saroj Kumar Jha


Background: Neonatal jaundice is extremely common as almost every new-born develops an unconjugated serum bilirubin level of more than 1.8 mg/dl during the first seven days of life. ABO incompatibility is associated in about 20% of all pregnancies but manifestations of ABO haemolytic disease of new-born occurs in <10% of these cases. True incidence of ABO incompatibility, particularly in developing countries like Nepal, is not understood sufficiently. Furthermore, the confirmation of severe ABO incompatibility cannot be made accurately using only a single test. Hence, this study was done to know the outcome of jaundice in ABO incompatibility patients.

Methods: This was a descriptive cross-sectional study done at Department of Paediatrics, between August 2018 to July 2019. All term neonates born to ‘O’ positive mother, with blood group A or B positive, and fulfilling the selection criteria were included in the study. Sample size was calculated to be 114 with confidence level at 95% and prevalence of ABO haemolytic disease as 11.4% with margin of error 5%.

Results: Severe ABO incompatibility as evident by presence of jaundice within 24 hours of life, a positive result on direct coomb’s test and haemolytic picture on peripheral blood smear was observed in 12% of the total enrolled 200 neonates. Modalities of treatment showed significant relation with severe ABO incompatibility indicating increased need for double volume exchange transfusion in neonates with severe ABO incompatibility.

Conclusions: Phototherapy was found to be effective in the management of most of the cases of neonatal jaundice in term ABO incompatible neonates but some cases, requiring exchange transfusion can occur, mostly in presence of positive result on direct Coomb’s test.


ABO incompatibility, DCT, Neonatal jaundice, Phototherapy

Full Text:



American Academy of Pediatrics. Subcommittee on hyperbilirubinemia. Clinical practice guidelines: Management of hyperbilirubinemia in newborn infants 35 or more weeks of gestation. 2004;114:297-16.

Dennery PA, Seidman D, Sand Stevenson DK. Neonatal hyperbilirubinemia. NEJM. 2001;344:58-90.

Maisels M. Jeffrey. Neonatal Jaundice. Pediatrics in review. 2006;27(12):443-53.

Ella EE, Garba SA, Ogala WN. ABO incompatibility and its role in neonatal jaundice in Zaria, Kaduna state of Nigeria. IJES. 2013;11(2):17-23.

Zuelzer WW, and Kaplan E. ABO heterospecific pregnancy and hemolytic disease. A study of normal and pathologic variants. American Journal of Disease of Children. 1953;88:179-92.

Roma KM, Kanodia P, Pyakurel M, Gupta V. A Study of Neonatal Hyperbilirubinemia in Mid-Western Part of Nepal. JNGMC. 2017;15:2.

Singh Ruchika, Jain Hemant. Prediction of significant hyperbilirubinemia by estimating cord blood bilirubin in neonates with ABO incompatibility. Int J Contemp Pediatr. 2019;6(2):670-5.

Akgül S, Korkmaz A, Yiğit S, Yurdakök M. Neonatal hyperbilirubinemia due to ABO incompatibility: does blood group matter. Turk J Pediatr. 2013;55(5):506-9.

Ella EE, Garba SA, Ogala WN. ABO incompatibility and its role in neonatal jaundice in Zaria, Kaduna state of Nigeria. IJES 2013;11(2):17-23.

Kattimani VS. Hemolytic disease of the new-born due to ABO incompatibility Int J Contemp Pediatr. 2018;5(2):605-11.

Gopu S, Begum A. A study on neonatal hyperbilirubinemia due to ABO incompatibility in sick newborn care unit, Telangana. Indian J Child Health. 2018; 5(6):425-7.

Sarici SU, Yurdakok M, Serdar MA, Oran O, Erdem S, Tekinalp G, et al. An Early (Sixth-Hour) Serum Bilirubin Measurement Is Useful in Predicting the Development of Significant Hyperbilirubinemia and Severe ABO Hemolytic Disease in a Selective High-Risk Population of Newborns With ABO Incompatibility. Pediatrics. 2002;109(4):e53.

Sharma DC, Rai S, Mehra A, Kaur MM, Sao S, Gaur A, et al. Study of 25 cases of exchange transfusion by reconstituted blood in hemolytic disease of newborn. Asian J Transfus Sci. 2007;1:56-8.

Osborn LM, Lenarsky C, Oakes RC, Reiff MI. Phototherapy in full term infants with hemolytic disease secondary to ABO-incompatibility. Pediatrics. 1984;74(3):371-4.