Value of the Direct Antiglobulin Test in Predicting the Need for Phototherapy in Newborns

Abstract

Purpose Guidelines for managing neonatal hemolytic disease of the newborn (HDN) recommend a selective approach in the use of direct antiglobulin test (DAT). In Saudi Arabia, many hospitals still perform routine DAT for all newborns. This study assessed the need for phototherapy in relation to DAT results in full-term healthy newborns. Patients and Methods A retrospective analysis of all healthy newborns admitted during 2018 was performed. The primary outcome was the association of positive DAT results with phototherapy. Results There were 1463 newborns born during the study period. The DAT was positive at 4.4%. The 24-hour bilirubin levels were higher in DAT-positive cases ( P =0.06); however, peak bilirubin levels were not correlated with the DAT results ( P =0.717). Thirty-six neonates (2.46%) required phototherapy, and the need was similar among DAT-positive and DAT-negative cases ( P =0.271). The most common indication for phototherapy was clinical jaundice in 22 neonates (61.1%), followed by DAT positivity in 12 (33.3%) and hospital protocol in 2 patients (5.6%) ( P <0.01 by chi-square overall comparison). Conclusion Our results indicate that factors other than DAT positivity are important in assessing the need for phototherapy in newborns. Clinical signs of jaundice were indicators of high serum bilirubin levels and subsequent phototherapy, further indicating that the DAT test was overused in predicting the need for phototherapy.

Utility of Direct Coomb’s test in a Tertiary Care Nursery

“…It is closer to the reported incidence of 6.6% in a study from Turkey but higher than the reported incidence of 2.3% in Australia and 2.59% in Greece. 15,16,10 In our study, ABO incompatibility has been a more frequent cause of positive DCT than Rh incompatibility (5.1% vs 0.7%). A similar discrepancy in results between ABO and Rh groups (4% vs 0.4%) by Alkhater et al in Saudi Arabia in 2021.…”

Maternal Blood Group and Routine Direct Antiglobulin Testing in Neonates: Is There a Role for Selective Neonatal Testing?

“…Phototherapy was required in 36 neonates (2.46%). The results of the phototherapy analysis are described in another study [16]. The most common indication for phototherapy was hyperbilirubinemia detected by clinical jaundice (61.1%), followed by DATpositive results (33.3%).…”

“…Data normality was tested using the Shapiro-Wilk test. Multiple logistic regression with the therapeutic use of phototherapy as the dependent variable was conducted as part of the analysis in another report [16].…”

Assistência de enfermagem em recém-nascidos com icterícia

“…A icterícia ocorre devido o aumento da concentração de bilirrubina plasmática no sangue, evidenciando a cor amareloalaranjada da pele do RN, como um dos principais sinais clínicos de fácil detecção no neonato (Dantas et al, 2018). Porém, somente as características de exames físicos não são suficientes para a elaboração do diagnóstico precoce no RN com icterícia, sendo necessário a quantificação da hiperbilirrubinemia no sangue (Alkhater et al, 2021;Yan et al, 2022). Logo, a realização de exames laboratoriais é algo fundamental e deve ser feito de forma rotineira ao RN, com intuito de detectar o aumento ou a redução desse composto no sangue durante os tratamentos, assim, exames através do hemograma, apresentam um resultado mais fidedigno (Hulzebos et al, 2021;Yan et al, 2022).…”