Clinical Features Of ABO Hemolytic Disease Of Newborn

BackgroundHemolytic disease of the newborn is a common cause of neonatal hyperbilirubinemia and anemia.ABO-hemolytic disease of newborn is the most common cause of HDN in China.During the first days after birth,the bilirubin-metabolizing system has not matured enough to conjugate and excrete the bilirubin load imposed by hemolysis,and the primary problem during the first days is jaundice.Bilirubin neurotoxicity in neonates is long-lasting with both function and structure that alters the processing of afferent input and leads to disordered efferent function.Moreover,it may lead to disordered clinical extrapyramidal function,and hearing,and learning,which may be associated with severe neurodevelopmental disabilities.Severe ABO HDN is relatively rare,however,severe hemolytic disease caused by ABO incompatibility requiring exchange blood transfusion have however been reported.The possibility of severe ABO HDN including erythroblastosis fetalis and kernicterus.Early detection and treatment is important in prevention of bilirubin-induced encephalopathy in the affected children.AimWe conducted this study to summarize the recent epidemiological characteristics of ABO HDN.We also evaluated the role of laboratory indexes played in predict the ABO HDN.MethodsPart oneClinical features of 409 cases of neonatal ABO incompatibility1.To summarize the clinical data of 409 cases of neonatal ABO incompatibility.Analysis the data of basic information as the gestational age,body weight,andlaboratory test results.2.Analysis the trement and hospitalization time of the babies.Part twoClinical Significance of Carboxyhemoglobin of Neonatal ABO Incompatibility1.Choose 75 cases of neonatal ABO incompatibility as case group,using 34 cases of normal group and 34 cases of non hemolytic j aundice cases as control.We compared each group of the gestational,body weight,and laboratory test results.2.Use the receiver operating characteristic(ROC),or ROC curve,to illustrates the performance of COHb,and optimum sensitivity and specificity for COHb.ResultsPart one1.Basic information:From Jan,2016 to Dec,2016,there were 8298 newborns admitted to neonatal ward,with 409 of them were diagnosed ABO hemolytic disease.190(46.5%)cases were male,and the The mean gestational age was 38.84±1.15 weeks.The age of admission was 3.57±2.05 days,the mean age of jaundice presentation was 1.97±0.95days.The mean birth weight was 3291±390 grams.2.laboratory test results:The mean TSB level on admission was 291.7±79.9mol/L,the mean COHb level was 1.31±0.67%,the mean Hb level was 159.3±26.7g/L,the positive rate of Antibody release test was 98.8%,the positive rate of direct coombs test was 9.8%.3.Treatment and outcomes:The mean time of phototherapy was 25.0±15.5 hours,intravenous albumin(23.7%),intravenous immunoglobulin(11%),exchange transfusion(5.1%),24.2%of them use the antibiotics,The mean hospital stay was 6.46±2.08 days.47of them were hearing abnormity,and 7 were diagnosed bilirubin encephalopathy.Part two1.Basic information and laboratory test results:There were no significant difference in mean gestational age and mean birth weight among the three groups;To the case group and the normal group the lever of the Hb and Ret were no significant difference(p>0.05),resultst it is statistics significance at difference of the lever of the TSB,COHb,and RBC(p<0.01);To the case group and the control group the lever of TSB were no significant difference(p>0.05),the lever of COHb,RBC,Hb and Ret showed significant differences(p<0.01).2.Clinical significance of COHb:The area under the receiver operating characteristic curve was 0.779,and the cut-off value of COHb was 1.45,the sensitivity was 65.3%,specificity was 85.3%.Conclusion1.Most of the cases of ABO-hemolytic disease of the newborn are mild.404 cases were treated with phototherapy(98.7%),and phototherapy is by far the most common treatment.ABO-hemolytic disease of the newborn always can achieve a good result,but sometimes an exchange transfusion is necessitated,and kernicterus may occur.3.COHb can use for the early diagnosis of ABO-hemolytic disease of the newborn,which is of great significance for diagnosis and guiding clinical therapy and prognosis.