Etiology and clinical profile of neonates with pathological unconjugated hyperbilirubinemia with special reference to Rhesus (Rh) D, C, and E incompatibilities: A tertiary care center experience
Abstract Objective To assess etiology, clinical profile, and outcome of pathological neonatal unconjugated hyperbilirubinemia, including various Rhesus (Rh) blood group incompatibilities. Methods This was a prospective observational study of 200 neonates, with unconjugated hyperbilirubinemia requiring phototherapy and/or exchange transfusion, presented at tertiary care neonatal unit during August 2011 to July 2012. Detailed history, physical examination, and laboratory work up were performed. In case, if major blood group incompatibility was found negative, the blood was further processed for G 6PD status, hereditary spherocytosis, and for non Rh D incompatibility by testing non Rh D antigens status in mother infant pair. Result ABO incompatibility (64 cases, 32% Rh D incompatibility (28 cases, 14% and sepsis (42 cases, 21% were major causes of neonatal unconjugated hyperbilirubinemia, while the etiology could not be ascertained in 31 (15.5% cases. Rh C and Rh E incompatibilities were observed in 28 (14% and 6 (3% cases, respectively among those neonates who did not exhibit major blood group incompatibility (ABO and Rh D) Rh C incompatibility was less severe than Rh D, and Rh E was least. Conclusions Blood group incompatibilities (ABO and Rh D) and sepsis are important causes of unconjugated hyperbilirubinemia in neonates requiring treatment. Though less common, non Rh D incompatibility can contribute to severe neonatal hyperbilirubinemia, and needs to be investigated.