Rates of phototherapy among ABO-incompatible newborns with a negative direct antiglobulin test

Abstract

Objective We analyze phototherapy rates after implementation of a Hyperbilirubinemia Clinical Pathway (HCP), which placed full-term ABOi DAT negative newborns on the low risk phototherapy nomogram, rather than medium risk, as previously done. Study design A chart review was performed for ABOi newborns born ≥36 weeks gestation between January 2020 and October 2021. Primary outcome measures were rates of phototherapy across pre- and post-intervention groups and among DAT negative newborns. Results There was an increased proportion of newborns assigned to the low risk curve after the intervention. There were no significant differences in phototherapy rates among the intervention groups, although there was a non-significant decrease in phototherapy rates among DAT negative newborns after the intervention. There were no increases in adverse outcomes. Conclusions Providers adhered to the guidelines after implementation of the HCP. ABOi DAT negative newborns can be viewed as low risk for hyperbilirubinemia requiring phototherapy.

Hereditary Thrombotic Thrombocytopenic Purpura

“…The most common cause of neonatal hyperbilirubinemia is ABO incompatibility, in which maternal antibodies cross the placenta to attack fetal red blood cells. In contrast to hTTP, the hyperbilirubinemia is not severe, and it resolves with phototherapy [21]. In a study of 878 deliveries, 17.3% neonates were at risk for hemolysis because they had blood groups A or B and were born to mothers with blood group O [22].…”

“…One-third of these neonates developed jaundice requiring phototherapy. Neonates who have red cell antigen incompatibility can be identified with a positive direct antiglobulin test [21].…”