Maternal Blood Group and Routine Direct Antiglobulin Testing in Neonates: Is There a Role for Selective Neonatal Testing?

Hwazen A Shash,Suzan A Alkhater

doi:10.3390/children8050426

Hwazen A Shash, Suzan A Alkhater

Open Access

https://doi.org/10.3390/children8050426

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Abstract

Recommendations for the screening of hemolytic disease of the newborn (HDN) advise taking a selective approach in using the direct antiglobulin test (DAT) for mothers with blood group O or RhD-negative. This study assessed the relation of DAT results to maternal and neonatal blood groups and evaluated the risk of HDN. A retrospective analysis of all healthy newborns admitted during 2018 was performed. Of 1463 newborns, 4.4% had a positive DAT. There were 541 (37%) maternal–neonatal pairs with ABO incompatibility, most commonly born to mothers with blood group O. The cohort of neonates born to mothers with blood group O was divided into three groups: the O-A and O-B groups and the O-O group as a control. The DAT was positive in 59 (8.3%) neonates; most were in the O-B group (49.2%), whereas 13.6% were in the control group (p < 0.01). While the neonates in the O-B group were more likely to require phototherapy (p = 0.03), this finding was not related to DAT results. We found that selective testing of mothers with blood group O, mothers with blood group O or RhD-negative, neonates with blood group B, and neonates with blood group B born to mothers with blood group O or RhD-negative was ineffective in detecting phototherapy requirements. Our results indicate no difference regarding the need for phototherapy in neonates born to mothers with different blood types regardless of the DAT results.

Highlights

Our results indicate no difference regarding the need for phototherapy in neonates born to mothers with different blood types regardless of the direct antiglobulin test (DAT) results
Hemolytic disease of the newborn (HDN) is a condition that occurs due to IgG antibodies that cross the placenta as a result of maternal sensitization to fetal red blood cell (RBC) antigens inherited from the father, leading to hemolysis and subsequent hyperbilirubinemia [1,2]
As the literature describes various methods for using the DAT to asses for HDN, our aim was to evaluate the need for routine DAT screening in healthy full-term newborns in our predominantly Arab population by correlating all maternal–neonatal blood types, bilirubin levels, and DAT findings with the need for phototherapy

Summary

Introduction

Hemolytic disease of the newborn (HDN) is a condition that occurs due to IgG antibodies that cross the placenta as a result of maternal sensitization to fetal red blood cell (RBC) antigens inherited from the father, leading to hemolysis and subsequent hyperbilirubinemia [1,2]. Rh immunoglobulin (anti-D IgG or RhoGAM); ABO incompatibility is the most common cause of HDN [2]. ABO-HDN is described as having a low incidence with a more benign presentation and outcome. ABO-HDN is almost exclusive to mothers with blood group O, as the naturally occurring antibodies are of the IgG subtype. This contrasts with individuals with blood group A or B, where the antibodies are predominantly IgM and do not cross the placenta [1]. The frequency of ABO incompatibility between a mother and neonate and the severity of HDN vary between ethnicities [3,5]. The literature differs on the type of ABO incompatibility, and whether maternal group O/neonate group A (O-A) or maternal group

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