Readmission for Newborn Jaundice: The Value of the Coombs’ Test in Predicting the Need for Phototherapy

Abstract

Current practice at our hospital is to perform a direct antiglobulin test (DAT) on cord blood samples of all infants born to blood type O or Rh-negative mothers. Measurement of serum total bilirubin (STB) level and follow-up after discharge are at the discretion of the individual physician. The purposes of the present study were, first, to determine the clinical utility of performing a routine DAT and, second, to define the clinical characteristics of infants readmitted to the hospital for phototherapy. The study was done over a 1-year period extending from January 1 to December 31, 2000. A retrospective review of the DAT results of all infants born to type O or Rh-negative mothers was conducted. The 2 groups of infants included those who had a positive cord blood DAT and were treated with phototherapy and those who needed readmission to the hospital for phototherapy. We found that routine DAT testing of cord blood from term nonjaundiced infants born to O positive mothers is not necessary. Infants with 2 or more risk factors for jaundice irrespective of the results of the DAT are at an increased risk for needing readmission for phototherapy.

Get full access to this article

View all access options for this article.

References

Bjure J , Liden G , Reinand T , et al. A follow-up study of hyperbilirubinemia in full-term infants without isoimmunization. Acta Pediatr. 1961;50:437-443.

Edmonson MB , Stoddard JJ , Owens LM . Hospital readmission with feeding-related problems after early post-partum discharge of normal newborns. JAMA. 1997;278:299-300.

Seidman DS , Stevenson DK , Ergaz Z , et al. Hospital readmission due to neonatal hyperbilirubinemia. Pediatrics. 1995;96:727-729.

McDonald MG . Hidden risks: early discharge and bilirubin toxicity due to glucose-6-phosphate dehydrogenase deficiency. Pediatrics. 1995;96:734-736.

Bhutani VK , Johnson L , Sivieri EM . Predictive ability of a predischarge hour-specific serum bililrubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103:6-14.

Newman TB , Escobar GJ , Branch PT , et al. Incidence of extreme hyperbilirubinemia in a large HMO. Amb Child Health. 1997;3:203(Abstract).

Maisels MJ , Newman TB . Kernicterus in otherwise healthy, breastfed term newborns. Pediatrics. 1995;96:730-733.

Brown AK , Johnson L . Loss of concern about jaundice and the reemergence of kernicterus in full-term infants in the era of managed care. In: Fanaroff AA , Klaus MH , eds. The Year Book of Neonatal and Perinatal Medicine. St Louis, MO: Mosby-Year Book; 1996:17-28.

Stevenson DK , Vreman HJ , Oh W , et al. Bilirubin production in healthy term infants as measured by carbon monoxide in breath. Clin Chem. 1994;40:1934-1939.

10.

Vreman HJ , Wong RJ , Harmatz P , et al. Validation of the Natus CO-Stat™ End Tidal Breath Analyzer in children and adults. J Clin Monit Comput. 1999;15:421-427.

11.

Stevenson DK , Fanaroff AA , Maisels J , et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics. 2001;18. url:http;//www.jcaho.org/ptsafety-frm.html.

12.

Joint Commission on Accreditation of Healthcare Organizations . Kernicterus threatens healthy newborns. Sentinel Event Alert 2001; issue 18 Kernicterus. JCAHO. 2001:18.

13.

Brown AK , Damus K , Kim MH , et al. Factors relating to readmission of term and near-term neonates in the first two weeks of life. J Perinat Med. 1999;27:263-275.

14.

Maisels MJ , Newman TB . Jaundice in full-term and near-term babies who leave the hospital within 36 hours. Clin Perinatol. 1998;25:295-302.

15.

Braveman P . Problems associated with early discharge of newborn infants: a critical review of the literature. Pediatrics. 1995;96:716-726.

16.

Gale R , Seidman DS , Dollberg S , Stevenson DK . Epidemiology of neonatal jaundice in the Jerusalem population. J Pediatr Gastroenterol Nutr. 1990;10:82-86.

17.

Bratlid D . Bililrubin toxicity: pathophysiology and assessment of risk factors. N Y J Med. 1991;91:489-492.

18.

19.

Kaplan E , Herz F , Scheye E . ABO hemolytic disease of the newborn without hyperbilirubinemia. Am J Hematol. 1976;1:279-282.

20.

Procianoy RS , Giacomini CB , Farina DM , et al. Early diagnosis of ABO hemolytic disease of the newborn. Eur J Pediatr. 1987;146:390-393.

21.

Schonitzer D , Frisch H . Incidence, laboratory diagnosis and serologic prediction of hemolytic disease of newborn infants due to ABO incompatibility. Pediatr Pathol. 1984;19:263-278.

22.

Risemberg HM , Mazzi E , MacDonald MG , et al. Correlation of cord bilirubin levels in hyperbilirubinemia in ABO incompatibility. Arch Dis Child. 1977;52:219-222.

23.

Serrao PA , Mofanlou HD . Significance of anti-A and anti-B isohemagglutinins in cord blood of ABO incompatible newborn infants: correlation with hyperbilirubinemia. J Perinatol. 1989;9:154-158.

24.

Leistikow EA , Collin MF , Savastano GD , et al. Wasted health care dollars. Routine cord blood type and Coombs’ testing. Arch Pediatr Adolesc Med. 1995;149:1147-1151.

25.

Maisels MJ , Kring E . Length of stay, jaundice and hospital readmission. Pediatrics. 1998;101:995-998.

26.

Beutler E , Gelbart T , Demina A . Racial variability in the UDP-glucuronsyltransferase 1 (UGT1A) promoter: a balanced polymorphism for regulation of bilirubin metabolism? Proc Natl Acad Sci USA. 1998;95:8170-8174.

27.

Kaplan M , Hammerman C . Glucose-6-phosphate dehydrogenase-deficient neonates: a potential cause for concern in North America. Pediatrics. 2000;106:1478-1480.

28.

Martinez JC , Garcia HO , Otheguy Le , et al. Control of severe hyperbilirubinemia in full-term newborns with the inhibitor of bilirubin production Sn-mesoporhyrin. Pediatrics. 1999;103:1-5.