Cord blood nucleated RBCs as a potential tool in prediction of neonatal hyperbilirubinemia in ABO incompatibility susceptible neonates
DOI:
https://doi.org/10.18203/2349-3291.ijcp20210106Keywords:
ABO incompatibility, nRBC, Neonatal hyperbilirubinemia, PhototherapyAbstract
Background: Neonatal hyperbilirubinemia is one of the most commonly encountered conditions in neonatal period. Early recognition and prompt intervention can prevent its dreadful complication like bilirubin encephalopathy. nucleated red blood cells (nRBC) are released into the peripheral circulation in conditions causing oxidative stress. This study aims at finding the relation between nRBC and neonatal hyperbilirubinemia.
Methods: This hospital based prospective cohort study was conducted on 100 neonates. The neonates were divided into 2 groups: Group 1- cases (n=50) included neonates born to O positive mothers with A/B blood groups and Group 2-controls (n=50) with neonates born to O positive mothers with O blood group. The cord blood nRBC, TSB at 48 hours and requirement of phototherapy were the variables which were considered. Statistical analysis was done using SPSS 22 version software with appropriate statistical methods applied.
Results: The mean cord nRBC was 7.26±2.65 (Group 1) and 3.04±0.92 (Group 2) respectively. ROC curve for cord nRBC revealed AUC 0.944 at 4.0 cut-off with sensitivity of 92%, specificity of 94%, LR+15.33 and LR-6.085 with p<0.0001.
Conclusions: Cord blood nucleated RBCs is a simple, easily available test to predict the neonatal hyperbilirubinemia in ABO incompatibility susceptible neonates.
References
Maisels MJ, Baltz RD, Bhutani VK, Newman TB, Rosenfeld W,Stevenson DK, et al. Neonatal jaundice and kernicterus. Pediatrics 2001;108:763–5.
Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med 2001;344:581–90.
Stevenson DK, Dennery PA, Hintz SR. Understanding newborn jaundice. J Perinatol 2001;21(Suppl 1):S21–4.
Dean L. Blood Groups and Red Cell Antigens: National Center for Biotechnology Information (US); 2005;4
Curty EM, Bradley CF. A randomized, controlled evaluation of early postpartum hospital discharge. Birth 1990;17:199–204.
Maisels MJ, Kring E. Length of stay, jaundice and hospital readmission. Pediatrics. 1998;101:995–8.
Lee K-S, Perlman M, Ballantyne M. Association between duration of neonatal hospital stay and readmission rate. J Pediatr. 1995;127:758–66.
Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed. 2001;84:F211–5.
Nicolaides KH, Thilaganathan B, Mibashan RS. Cordocentesis in the investigation of fetal erythropoiesis. Am J Obstet Gynecol 1989;161:1197–200.
Leikin E, Verma U, Klein S, Tejani N. Relationship between neonatal nucleated red blood cell counts and hypoxic-ischemic injury. Obstet Gynecol. 1996;87:439–43.
Orhon A, Topal H, Hakan N, Ozer EA. Cord blood nucleated red blood cell level: is it a predictive marker for neonatal jaundice?. J Lab Medic. 2018;42(5):171-5.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297–316.
Keren R, Bhutani VK, Luan X, Nihtianova S, Cnaan A, Schwartz JS. Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches. Arch Dis Child 2005;90:415–42.
Baranano DE, Rao M, Ferris CD, Snyder SH. Biliverdin reductase: a major physiologic cytoprotectant. Proc Natl Acad Sci USA 2002;99:16093–8.
Turgut M, Basaran O, Cekmen M, Karatas F, Kurt A, Aygun AD.Oxidant and antioxidant levels in preterm newborns with idiopathic hyperbilirubinaemia. J Paediatr Child Health. 2004;40:633–7.
Dennery PA, Weng YH, Stevenson DK, Yang G. The biology of bilirubin production. J Perinatol. 2001;21(Suppl 1):S17–20.
Choi AM, Alam J. Heme oxygenase-1: function, regulation,and implication of a novel stress-inducible protein in oxidant-induced lung injury. Am J Respir Cell Mol Biol. 1996;15:9–19.
Applegate LA, Luscher P, Tyrrell RM. Induction of hemeoxygenase: a general response to oxidant stress in cultured mammalian cells. Cancer Res 1991;51:974–8.
Van Rossum HH, de Kraa N, Thomas M, Holleboom CAG, Castel A, van Rossum AP. Comparison of the direct antiglobulin test and the eluate technique for diagnosing haemolytic disease of the newborn. Pract Lab Med. 2015;3:17-22.
