Usefulness of maternal red cell antibodies to predict severe neonatal hyperbilirubinemia

What is it about?

Maternal-fetal blood group incompatibility can cause hemolytic disease of the newborn(HDFN) and hyperbilirubinemia. Since the introduction of ante- and postnatal anti-D prophylaxis, the incidence of HDFN due to anti-D decreased dramatically. Other erythrocyte alloantibodies, in particular anti-K and anti-c, are less frequent but are an important cause of severe HDFN. In this study the predictive value of erythrocyte alloantibodies for significant hyperbilirubinemia and HDFN was assessed.

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Why is it important?

Post-test probability for significant hyperbilirubinemia or HDFN was low if maternal allo-antibodies were present (12%) of direct antiglobulin test (DAT) on umbilical cord blood (UCB) was positive (15%). However likelihood ratios were clearly elevated in these situations. Newborns with an UCB bilirubin value > 42.75 µmol/L (2.5 mg/dL) have a higher post-test probability (21%) for significant hyperbilirubinemia than those with presence of maternal allo-antibodies or a positive UCB DAT. Combining results of these tests, identifies newborns with a high probability of developing significant hyperbilirubinemia shortly after birth. Therefore, we would recommend UCB bilirubin and DAT testing in newborns combined with ABO compatibility analysis.

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