Values of early diagnosis of neonatal ABO hemolytic disease with cord blood to prevent severe hyperbilirubinemia

doi:10.3877/cma.j.issn.1673-5250.2018.02.009

Objective

To explore the values of prevention of severe hyperbilirubinemia through early diagnosis of neonatal ABO hemolytic disease by cord blood direct antiglobulin test (DAT) and antibody release test.

Methods

A total of 655 late preterm and full term infants were chosen as study subjects. They were diagnosed as ABO hemolytic disease from June 2013 to June 2016 in Department of Neonatology in West China Second University Hospital, Sichuan University. A total of 188 cases of ABO hemolytic disease neonates who were diagnosed with cord blood DAT and antibody release test at birth were assigned into observation group, and 467 ABO hemolytic disease neonates who were diagnosed with venous blood DAT and antibody release test after admitted to hospital were assigned into control group. Case informations of two groups were retrospectively analyzed. The general clinical data, main indexes of laboratory examination results, treatments, and short term prognosis were statistically compared between two groups by t test or chi-square test. All guardians of research subjects signed the informed consents.

Results

①The age of admission to hospital and discovery of jaundice in observation group were all younger than those in control group [(34.3±21.8) h vs (58.8±34.3) h, (22.0±12.8) h vs (32.3±19.0) h, respectively], the levels of total serum bilirubin (TSB) and hemoglobin (Hb) in observation group were lower than those in control group [(185.5±49.2) μmol/L vs (243.3±85.1) μmol/L, (147.3±21.6) g/L vs (153.8±24.9) g/L, respectively], proportion of cesarean section in observation group was higher than that in control group (70.2% vs 56.5%), and all the differences above were statistically significant (t=9.071, P<0.001; t=6.831, P<0.001; t=8.743, P<0.001; t=3.132, P=0.002; χ²=10.492, P=0.001). ②The blood exchange transfusion rates and albumin usage rates in observation group were all lower than those in control group (0 vs 9.0%, 9.6% vs 22.5%, respectively), and the differences were statistically significant (χ²=18.532, P<0.001; χ²=15.151, P<0.001). ③A total of 7 neonates with bilirubin encephalopathy were all in control group.

Conclusions

Screening ABO hemolytic disease by cord blood DAT and antibody release test at birth can strengthen physicians and guardians′ awareness of jaundice monitoring of neonatal ABO hemolytic disease, and to find out the infants who need phototherapy, to avoid severe hyperbilirubinemia and bilirubin encephalopathy which need blood exchange transfusion therapy.

Key words: ABO blood-group system, Blood group incompatibility, Fetal blood, Hyperbilirubinemia, Kernicterus, Infant, newborn

表1 2组患儿一般临床资料及主要实验室检查结果比较

组别	例数	入院年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	性别[例数(%)]		分娩方式[例数(%)]
组别	例数	入院年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	男	女	剖宫产	顺产
研究组	188	34.3±21.8	39.0±1.3	3 359±450	89(47.3)	99(52.7)	132(70.2)	56(29.8)
对照组	467	58.8±34.3	38.9±1.4	3 325±447	214(45.8)	253(54.2)	264(56.5)	203(43.5)
检验值	?	t＝9.071	t＝0.752	t＝1.412	χ²＝0.121		χ²＝10.492
P值	?	<0.001	0.453	0.122	0.734		0.001
组别	例数	胎次[例数(%)]			喂养方式[例数(%)]		发现黄疸时年龄(h，±s)^a	入院时TSB浓度(μmol/L，±s)
组别	例数	1次	2次	≥3次	母乳喂养	混合喂养	发现黄疸时年龄(h，±s)^a	入院时TSB浓度(μmol/L，±s)
研究组	188	82(43.7)	36(19.1)	70(37.2)	65(34.6)	123(65.4)	22.0±12.8	185.5±49.2
对照组	467	202(43.2)	133(28.5)	132(28.3)	150(32.1)	317(67.9)	32.3±19.0	243.3±85.1
检验值	?	χ²＝22.462			χ²＝0.363		t＝6.831	t＝8.743
P值	?	0.323			0.551		<0.001	<0.001
组别	例数	入院时Hb水平(g/L，±s)	入院时贫血[例数(%)]	血型[例数(%)]		DAT阳性[例数(%)]	抗体释放试验阳性[例数(%)]	游离抗体试验阳性[例数(%)]
组别	例数	入院时Hb水平(g/L，±s)	入院时贫血[例数(%)]	A型	B型	DAT阳性[例数(%)]	抗体释放试验阳性[例数(%)]	游离抗体试验阳性[例数(%)]
研究组	188	147.3±21.6	84(44.7)	96(51.1)	92(48.9)	42(22.3)	182(96.8)	183(97.3)
对照组	467	153.8±24.9	171(36.6)	268(57.4)	199(42.6)	116(24.8)	441(94.4)	443(94.9)
检验值	?	t＝3.132	χ²＝3.672	χ²＝4.463		χ²＝0.464	χ²＝1.632	χ²＝1.953
P值	?	0.002	0.063	0.112		0.486	0.204	0.158

表1 2组患儿一般临床资料及主要实验室检查结果比较

组别	例数	入院年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	性别[例数(%)]		分娩方式[例数(%)]
组别	例数	入院年龄(h，±s)	胎龄(周，±s)	出生体重(g，±s)	男	女	剖宫产	顺产
研究组	188	34.3±21.8	39.0±1.3	3 359±450	89(47.3)	99(52.7)	132(70.2)	56(29.8)
对照组	467	58.8±34.3	38.9±1.4	3 325±447	214(45.8)	253(54.2)	264(56.5)	203(43.5)
检验值	?	t＝9.071	t＝0.752	t＝1.412	χ²＝0.121		χ²＝10.492
P值	?	<0.001	0.453	0.122	0.734		0.001
组别	例数	胎次[例数(%)]			喂养方式[例数(%)]		发现黄疸时年龄(h，±s)^a	入院时TSB浓度(μmol/L，±s)
组别	例数	1次	2次	≥3次	母乳喂养	混合喂养	发现黄疸时年龄(h，±s)^a	入院时TSB浓度(μmol/L，±s)
研究组	188	82(43.7)	36(19.1)	70(37.2)	65(34.6)	123(65.4)	22.0±12.8	185.5±49.2
对照组	467	202(43.2)	133(28.5)	132(28.3)	150(32.1)	317(67.9)	32.3±19.0	243.3±85.1
检验值	?	χ²＝22.462			χ²＝0.363		t＝6.831	t＝8.743
P值	?	0.323			0.551		<0.001	<0.001
组别	例数	入院时Hb水平(g/L，±s)	入院时贫血[例数(%)]	血型[例数(%)]		DAT阳性[例数(%)]	抗体释放试验阳性[例数(%)]	游离抗体试验阳性[例数(%)]
组别	例数	入院时Hb水平(g/L，±s)	入院时贫血[例数(%)]	A型	B型	DAT阳性[例数(%)]	抗体释放试验阳性[例数(%)]	游离抗体试验阳性[例数(%)]
研究组	188	147.3±21.6	84(44.7)	96(51.1)	92(48.9)	42(22.3)	182(96.8)	183(97.3)
对照组	467	153.8±24.9	171(36.6)	268(57.4)	199(42.6)	116(24.8)	441(94.4)	443(94.9)
检验值	?	t＝3.132	χ²＝3.672	χ²＝4.463		χ²＝0.464	χ²＝1.632	χ²＝1.953
P值	?	0.002	0.063	0.112		0.486	0.204	0.158

表2 2组患儿治疗、近期预后及胆红素脑病发生率比较

组别	例数	光疗时间(h，±s)	换血[例数(%)]	输血[例数(%)]	输注白蛋白[例数(%)]	静脉输注IVIG[例数(%)]
研究组	188	103.2±39.8	0(0)	22(11.6)	18(9.6)	64(34.0)
对照组	467	98.2±40.5	42(9.0)	43(9.2)	105(22.5)	124(26.6)
检验值	?	t＝1.431	χ²＝18.532	χ²＝0.931	χ²＝15.151	χ²＝3.675
P值	?	0.151	<0.001	0.332	<0.001	0.055
组别	例数	住院时间(d，±s)	出院时TSB浓度(μmol/L，±s)	出院时Hb水平(g/L，±s)	出院4 d内因黄疸再入院[例数(%)]	胆红素脑病[例数(%)]
研究组	188	4.8±1.7	135.2±37.8	153.4±21.3	11(5.9)	0(0)
对照组	467	4.5±1.8	134.9±37.5	155.1±22.8	23(4.9)	7(1.5)
检验值	?	t＝1.461	t＝0.892	t＝0.823	χ²＝0.231	χ²＝1.607
P值	?	0.151	0.942	0.412	0.631	0.205

表2 2组患儿治疗、近期预后及胆红素脑病发生率比较

组别	例数	光疗时间(h，±s)	换血[例数(%)]	输血[例数(%)]	输注白蛋白[例数(%)]	静脉输注IVIG[例数(%)]
研究组	188	103.2±39.8	0(0)	22(11.6)	18(9.6)	64(34.0)
对照组	467	98.2±40.5	42(9.0)	43(9.2)	105(22.5)	124(26.6)
检验值	?	t＝1.431	χ²＝18.532	χ²＝0.931	χ²＝15.151	χ²＝3.675
P值	?	0.151	<0.001	0.332	<0.001	0.055
组别	例数	住院时间(d，±s)	出院时TSB浓度(μmol/L，±s)	出院时Hb水平(g/L，±s)	出院4 d内因黄疸再入院[例数(%)]	胆红素脑病[例数(%)]
研究组	188	4.8±1.7	135.2±37.8	153.4±21.3	11(5.9)	0(0)
对照组	467	4.5±1.8	134.9±37.5	155.1±22.8	23(4.9)	7(1.5)
检验值	?	t＝1.461	t＝0.892	t＝0.823	χ²＝0.231	χ²＝1.607
P值	?	0.151	0.942	0.412	0.631	0.205

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