Is the incidence of ABO blood groups incompatibility among Egyptian mothers and its relation to critical neonatal hyperbilirubinemia in healthy term and near-term newborns worth screening? Al Galaa Teaching Hospital experience

Abstract Background Newborn infants with maternal-fetal ABO blood group system incompatibility face an increased risk of developing significant hyperbilirubinemia; early detection during the first 24 h and in subsequent days of life is of crucial importance. The aim of this study was to evaluate the usefulness of transcutaneous bilirubin measurement in screening for critical bilirubin level in healthy-term neonates born to group O-positive mothers. Methods This retrospective descriptive and analytical cohort study was conducted at Al Galaa Teaching Hospital in Egypt from January 2017 through December 2019 using hospital records. Blood group O-positive mothers and their newborn infants were investigated for ABO incompatibility. The bilirubin levels were measured after delivery and on follow-up during the first 5 days of life. Hyperbilirubinemia was defined as an (TcB1) initial transcutaneous bilirubin > 4 mg/dL and (TcB2) second transcutaneous bilirubin measurement > 10 mg/dL based on the Bhutani nomogram to predict critical levels. Results In total, 1455 newborns of mothers with the O positive blood group were males (50.8%) and females (49.2%), with a mean weight of 2.86 ± 0.38 SD and a gestational age of 38.54 ± 1.26 SD, with 51.4% early term. Increased TcB1 and TcB2 in newborn infants with blood groups A and B with incidence of hyperbilirubinemia of 29.4% and 35.8%, respectively, while the incidence of hemolytic disease of the newborn (HDN) was 6.17%. The mean day of follow-up was 3.02 ± 0.94. There was a statistically significant positive correlation between TcB1 and TcB2. Statistically significant results were observed in mothers with a positive history of abortion and stillbirth, newborns with a history of siblings with neonatal jaundice, and breastfeeding. Management of the studied neonates was follow-up in 95.3%, exchange transfusion in 13 (0.9%), and 55 (3.8%) required phototherapy. TcB1 and TcB2 predicted significant hyperbilirubinemia in positive ABO incompatibility with cut-off levels of 3.75 and 10.05 mg/dL, respectively. Conclusion In ABO incompatibility, TcB measurement in the early days of life can be used as a screening for critical hyperbilirubinemia in term neonates with blood groups A and B, and those of mothers with a history of miscarriage and neonatal sibling with jaundice.