Clinical analysis of neonatal ABO hemolytic disease with hyperbilirubinemia in full-term infants

doi:10.3877/cma.j.issn.1673-5250.2016.02.005

Objective

To analyze characteristics of clinical manifestations, laboratory test results, therapeutic measurements and early prognosis of neonatal ABO incompatibility hemolytic disease (simply as"ABO hemolytic disease") with hyperbilirubinemia in full-term infants, and provid directions of reasonable management of this disease.

Methods

A total of 331 cases of full-term infants who were confirmed neonatal ABO hemolytic disease with hyperbilirubinemia by laboratory tests, and hospitalized in department of neonatology, West China Second University Hospital, Sichuan University from January 2012 to December 2014 were chosen as study objects. Clinical manifestations, laboratory test results, therapeutic measurements and early prognosis of medical history of these 331 cases were analyzed, retrospectively. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University.Informed consent was obtained from the parents of each participant.

Results

The admission mean age was (53.5±36.2) h of these 331 cases of full-term neonatal ABO hemolytic disease with hyperbilirubinemia, 48.0%(159/331) patients were boys, 45.0%(149/331) patients were born from the first pregnancy, 59.2%(196/331) patients were cesarean delivery, 71.6%(237/331) patients were mixed feeding, the mean jaundice noticed time was (29.7±19.4) h after born.The admission mean total serum bilirubin (TSB) was (233.1±90.9) μmol/L, the TSB concentration of 9.4%(31/331) patients were>342.0 μmol/L, the highest was 614.7 μmol/L, 14.5%(48/331) patients were admitted to hospital with anemia, 56.8%(188/331) patients with type A blood, the rate of eluate positive for anti-A/B test was higher than that of direct antiglobulin test(DAT)(95.5% vs 29.0%), and the difference was statistically significant(χ²=311.076, P=0.000). Mean phototherapy time was (80.1±20.9) h, 8.8%(29/331) patients accepted blood exchange-transfusions and blood transfusions, 19.0%(63/331) patients accepted albumin infusion, 26.0%(86/331) patients accepted intravenous immune globulin infusion.0.9%(3/331) patients with clinical diagnosis of bilirubin encephalopathy, average hospitalization was (4.7±1.8) d, 1.8%(6/331) patients readmitted within 4 days after discharge because of jaundice.

Conclusions

Full-term neonatal ABO hemolytic disease with hyperbilirubinemia may occur anemia and serious hyperbilirubinemia, leading to bilirubin encephalopathy. Eluate positive for anti-A/B test may be as a routine laboratory examination to increase diagnostic rate of neonatal ABO hemolytic disease.Jaundice may last a long time, patients should pay attention to jaundice follow-up until it disappear after discharge.

Key words: ABO blood-group system, Blood group incompatibility, Hyperbilirubinemia, Phototherapy, Exchange transfusion, whole blood, Kernicterus, Infant, newborn

表1 331例足月新生儿ABO溶血病患儿临床资料、实验室检查结果、治疗措施及近期预后情况[例数(%)]

观察指标		观察值	观察指标		观察值	观察指标	观察值
入院年龄(h,±s)		53.5±36.2	喂养方式构成比			抗体释放试验阳性率	316(95.5)
胎龄(周，±s)		39.2±1.1		母乳喂养	94(28.4)	光疗时间(h, ±s)	80.1±20.9
出生体重(g, ±s)		3 311±435		混合喂养	237(71.6)	换血率	29 (8.8)
性别构成比			生后发现黄疸时间(h，±s)		29.7±19.4	输血率	29 (8.8)
	男	159(48.0)	入院时TSB浓度(μmol/L, ±s)		233.1±90.9	输注白蛋白率	63(19.0)
	女	172(52.0)	入院时Hb水平(g/L, ±s)		151.2±24.1	输注静脉免疫球蛋白率	86(26.0)
胎次构成比			入院时贫血比例		48(14.5)	新生儿胆红素脑病发生率	3 (0.9)
	1	149(45.0)	血型构成比			住院天数(d, ±s)	4.7±1.8
	2	84(25.4)		A型	188(56.8)	出院时TSB浓度(μmol/L，±s)	136.0±36.8
	≥3	98(29.6)		B型	143(43.2)	出院时Hb水平(g/L, ±s)	153.8±22.2
分娩方式构成比			DAT阳性率		96(29.0)	出院4 d内再入院率	6 (1.8)
	剖宫产	196(59.2)
	顺产	135(40.8)

表1 331例足月新生儿ABO溶血病患儿临床资料、实验室检查结果、治疗措施及近期预后情况[例数(%)]

观察指标		观察值	观察指标		观察值	观察指标	观察值
入院年龄(h,±s)		53.5±36.2	喂养方式构成比			抗体释放试验阳性率	316(95.5)
胎龄(周，±s)		39.2±1.1		母乳喂养	94(28.4)	光疗时间(h, ±s)	80.1±20.9
出生体重(g, ±s)		3 311±435		混合喂养	237(71.6)	换血率	29 (8.8)
性别构成比			生后发现黄疸时间(h，±s)		29.7±19.4	输血率	29 (8.8)
	男	159(48.0)	入院时TSB浓度(μmol/L, ±s)		233.1±90.9	输注白蛋白率	63(19.0)
	女	172(52.0)	入院时Hb水平(g/L, ±s)		151.2±24.1	输注静脉免疫球蛋白率	86(26.0)
胎次构成比			入院时贫血比例		48(14.5)	新生儿胆红素脑病发生率	3 (0.9)
	1	149(45.0)	血型构成比			住院天数(d, ±s)	4.7±1.8
	2	84(25.4)		A型	188(56.8)	出院时TSB浓度(μmol/L，±s)	136.0±36.8
	≥3	98(29.6)		B型	143(43.2)	出院时Hb水平(g/L, ±s)	153.8±22.2
分娩方式构成比			DAT阳性率		96(29.0)	出院4 d内再入院率	6 (1.8)
	剖宫产	196(59.2)
	顺产	135(40.8)

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