Performing a 24-hour bilirubinBilirubin A yellow substance produced when red blood cells break down. High bilirubin levels in newborns with HDFN can cause jaundice or, in severe cases, brain damage. screening after birth led to early detection of newborns with hemolytic disease of the fetus and newborn (HDFN) and other severe conditions that qualified for phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus. , according to a recently published study in The Journal of Pediatrics.
As jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes. surveillance is considered optional by the American Academy of Pediatrics, the authors aimed to assess its utility in detecting patients requiring PT through a single-center study.
“Recommended birth hospitalization surveillance includes i) the visual assessment for jaundice at least every 12 hours following delivery until discharge, ii) measurement of a total serum bilirubin (TSB) as soon as possible for infants noted to be jaundiced < 24 hours after birth, and iii) measurement of TSB or transcutaneous (TcB) bilirubin between 24 and 48 hours of age,” the authors wrote.
Out of over 6000 babies born from O+ mothers whose anti-erythrocyte antibody screenAntibody test A blood test performed during pregnancy to look for antibodies that could affect a developing fetus. was negative, 89 met the criteria for 24-hour jaundice surveillance; this means they tested positive for a direct antiglobulin testDirect antiglobulin test A blood test used to detect antibodies attached to red blood cells. It helps confirm HDFN in newborns. (DATDirect antiglobulin test A blood test used to detect antibodies attached to red blood cells. It helps confirm HDFN in newborns.) indicative of anti-erythrocyte antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens.,
The 59 newborns that met jaundice surveillance criteria received phototherapy in the first 24 hours after birth. ABO HDFN was the cause of jaundice in 48 of the newborns and the rest had glucose-6-phosphate dehydrogenase deficiency.
In most cases, physicians began phototherapy because of TcBs obtained at the 24-hour mark and in 17%, the TcB at the 13-hour mark. Visual assessment of jaundice was of little value in triggering phototherapy.
30 newborns met the criteria for jaundice surveillance but did not meet the criteria for phototherapy in the first 24 hours after birth.
Jaundice, or yellowish coloration of the skin and eyes is a consequence of bilirubin accumulation, a frequent consequence of red blood cell (RBC) destruction. Excessively high bilirubin treatment can lead to permanent neurological damage in newborns (kernicterusKernicterus A rare but serious brain condition caused by very high bilirubin levels.). Therefore, early detection and appropriate treatment are vital.
“Our findings support routine birth hospitalization bilirubin screening and suggest screening no later than 24 hours may be beneficial,” the authors concluded.
