Pathological Jaundice Research Articles

Pseudomonas UTI Masquerading as Neonatal Jaundice: A Case Report

The pathological jaundice in neonates develops due to hematological, infectious, surgical causes. We present an interesting case of persistent neonatal hyperbilirubinemia, who was diagnosed to have urinary tract infection (UTI) and effectively managed. Unexplained persistent neonatal jaundice, poor response to phototherapy, and higher rebound total serum bilirubin levels should be evaluated for UTI.

Development of a diagnostic model for biliary atresia based on MMP7 and serological tests using machine learning.

To develop a machine learning diagnostic model based on MMP7 and other serological testing indicators for early and efficient diagnosis of biliary atresia (BA). A retrospective analysis was conducted on patient information from those hospitalized for pathological jaundice at Beijing Children's Hospital between January 1, 2019, and December 31, 2023. Patients with serum MMP7, liver stiffness measurements, and other routine serological tests were included in the study. Six machine learning models were constructed, including logistic regression (LR), random forest (RF), decision tree (DET), support vector machine classifier (SVC), neural network (MLP), and extreme gradient boosting (XGBoost), to diagnose BA. The area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the various models. A total of 98 patients were included in the study, comprising 64 BA patients and 34 patients with other cholestatic liver diseases. Among the six machine learning models, the XGBoost algorithm model and RF algorithm model achieved the best predictive performance, with an AUROC of nearly 100% in both the training and validation sets. In the training set, these two algorithm models achieved an accuracy, precision, recall, F1 score, and AUROC of 1. Through model interpretation analysis, serum MMP7 levels, serum GGT levels, and acholic stools were identified as the most important indicators for diagnosing BA. The nomogram constructed based on the XGBoost algorithm model also demonstrated convenient and efficient diagnostic efficacy. Machine learning models, especially the XGBoost algorithm and RF algorithm models, constructed based on preoperative serum MMP7 and serological tests can diagnose BA more efficiently and accurately. The most important influencing factors for diagnosis are serum MMP7, serum GGT, and acholic stools.

The Association Between Asphyxia and Neonatal Pathological Jaundice Incidence in Umbu Rara Meha Hospital East Sumba Regency

Jaundice causes 70% morbidity and 10% infant mortality worldwide, approximately 1.1 million newborns are affected by jaundice every year. The purpose of this study was to analysis the association between asphyxia and the incidence of neonatal pathological jaundice at Umbu Rara Meha Hospital, East Sumba Regency. The research used a quantitative method with case and control approach using secondary collection data medical records from January to October 2023. The sample ratio was 1:1, the case group sample is 75 babies with jaundice and the control group sample is 75 babies who were born in the hospital. The sampling taken by consecutive sampling. The analysis used the Chi-square test. The data analysis showed there was an association between asphyxia and neonatal pathological jaundice incidence with p=0.001. The data result showed there was an association between asphyxia and neonatal pathological jaundice incidence at Umbu Rara Meha Hospital, East Sumba Regency.

Distinct effects of racial and socioeconomic disparities on biliary atresia diagnosis and outcome.

To identify and distinguish between racial and socioeconomic disparities in age at hepatology care, diagnosis, access to surgical therapy, and liver transplant-free survival in patients with biliary atresia (BA). Single-center retrospective cohort study of 69 BA patients from 2010 to 2021. Patients were grouped into White and non-White cohorts. The socioeconomic milieu was analyzed utilizing neighborhood deprivation index, a census tract-based calculation of six socioeconomic variables. The primary outcomes of this study were timing of the first hepatology encounter, surgical treatment with hepatic portoenterostomy (HPE),and survival with native liver (SNL) at 2years. Patients were 55% male and 72% White. White patients were referred at a median of 34 days (interquartile range [IQR]: 17-65) vs. 67 days (IQR: 42-133; p = 0.001) in non-White patients. White infants were more likely to undergo HPE (42/50 patients; 84%) compared to non-White (10/19; 53%), odds ratio (OR) 4.73 (95% confidence interval: 1.46-15.31; p = 0.01). Independent of race, patients exposed to increased neighborhood-level deprivation were less likely to receive HPE (OR: 0.49, p = 0.04) and achieve SNL (OR: 0.54, p = 0.02). Racial and socioeconomic disparities are independently associated with timely BA diagnosis, access to surgical treatment, and transplant-free survival. Public health approaches to improve screening for pathologic jaundice in infants of diverse racial backgrounds and to test and implement interventions for socioeconomically at-risk families are needed.

Effect of intravenous immunoglobulin on the management of Rh- and ABO-mediated hemolytic disease of the newborn

BackgroundRegarding the close association between neonatal hyperbilirubinemia and occurrence of pathological jaundice as a cause of neurotoxicity and kernicterus, the present study aimed to evaluate the use of intravenous immunoglobulin (IVIG) in neonates with hyperbilirubinemia. MethodsA retrospective case-control study of blood group O mothers and their ABO and Rh newborns was conducted. Medical records that included total serum bilirubin levels of 79 patients with hemolytic disease of the newborn (HDN) from between 2017 and 2020 were reviewed. Neonates who were eligible to receive immunoglobulin based on the American Academy of Pediatrics (AAP) guidelines were classified as cases and the rest were included as the Control Group. ResultsThe mean total bilirubin in relation to hemoglobin levels in IVIG-treated neonates was significantly lower than in non-IVIG-treated neonates (13.98 ± 4.23 mg/dL versus 16.61 ± 2.68 mg/dL; p-value = 0.002). Although females had longer hospitalizations in both IVIG-treated (3.81 ± 1.28 versus 3.54 ± 1.30 days; p-value = 0.509) and non-IVIG-treated (3.43 ± 0.811 versus 3.19 ± 0.75 days; p-value = 0.361) groups compared to males, this difference was not significant between the groups. Although four neonates with ABO incompatibility required packed red blood cells, all infants were managed medically and no deaths occurred during the course of treatment. Moreover, no exchange transfusion or adverse effects of IVIG were observed. ConclusionThe results from the present study revealed that IVIG administration is a useful procedure for the management of bilirubin encephalopathy with greater opportunity to reduce exchange transfusion requirements for neonatal hyperbilirubinemia.

Therapeutic Effects of Probiotics In The Reduction of Neonatal Hyperbilirubinemia

Objective: To evaluate probiotics' effects in reducing hyperbilirubinemia in late preterm and term neonates. Study Design: Quasi-experimental study Place and Duration of Study: Department of Neonatology, Pakistan Institute of Medical Sciences (PIMS), Islamabad Pakistan, from Oct 2018 to Mar 2019. Methodology: The quasi-experimental study was conducted on 60 neonates with hyperbilirubinemia. They were randomlydivided into two Groups. Group-A (n=30) received phototherapy. Group-B (n=30) received probiotics containing Lactobacillus reuteri at a dose of 5 drops daily for three days, in addition to phototherapy. Total serum bilirubin was calculated at 0, 24 and 72 hours for both Groups. Results: In Group-A, the mean total bilirubin in mg/dl at 0, 24 and 72 hours were 18.14±2.35, 15.28±2.93 and 12.31±2.29, respectively. Similarly, in Group-B, it was 19.86±5.85, 16.23±4.01 and 10.75±2.23 at 0, 24 and 72 hours, respectively. There was an insignificant statistical difference in mean total bilirubin between Groups A and B at 0 and 24 hours (p<0.001). However, when comparison was made at 72 hours, a significant statistical difference was observed in Group-B (Intervention Group) (p=0.005) Conclusion: Probiotics significantly lowered total serum bilirubin in neonates with hyperbilirubinemia. Further studies are required to evaluate its role in physiological and pathological jaundice.

Incidence of prolonged transitional neonatal hypoglycemia and associated factors among neonatal admissions in South Gondar public hospitals, North-Central Ethiopia: a prospective cross-sectional study.

Unlike in developed countries, neonatal morbidity and mortality are the leading challenges associated with easily preventable and treatable disorders during the neonatal period in low- and middle-income countries. However, evidence-based data about prolonged transitional hypoglycemia and associated factors are highly limited in Ethiopia and resource-limited countries. An institution-based prospective cross-sectional study was conducted at public hospitals in South Gondar in neonatal intensive care units (NICUs). The data were entered and analyzed using SPSS version 23. Descriptive statistics were used to summarize maternal characteristics. Multivariate binary logistic regression at a p value <0.05 was used. A total of 400 neonates, admitted to NICUs in public hospitals within 48-72 h of birth between October 2, 2021, and June 30, 2022, were included in the study. The incidence of prolonged transitional neonatal hypoglycemia (PTHG) was 23.5% (19.3%-28%). The factors associated with PTHG were hypothermia (AOR = 4.41; 95% CI = 2.72-10.92), preterm birth (AOR = 3.5; 95% CI = 1.69-11.97), perinatal asphyxia (AOR = 2.5; 95% CI = 1.34-9.67), and pathological jaundice (AOR = 2.3; 95% CI = 1.21-10.34). In contrast, spontaneous vaginal delivery (SVD) was a protective factor (AOR = 0.72; 95% CI = 0.35-0.88). The incidence of (PTHG) was nearly one-fifth. Factors increasing the risk of PTHG were hypothermia, preterm birth, perinatal asphyxia (PNA), early onset of sepsis (EONS), and pathological jaundice. Spontaneous vaginal delivery (SVD) was also a protective factor. Preventing neonatal hypothermia was the main measure used to reduce PTHG in the study area. Special attention could be given to neonates with prematurity, early onset neonatal sepsis (EONS), birth asphyxia, and pathological jaundice, as monitoring their RBS could lead to a significant change in reducing PTHG.

Clinical value of combined predictors of RET%, γ-GT, LDH in the ABO neonatal hemolytic disease.

The purpose of this study is to examine the prognostic significance of the amalgamated indicators, reticulocyte percentage (RET%), lactate dehydrogenase (LDH), and γ-Glutamyltransferase (γ-GT), in neonatal ABO hemolytic disease. A total of 137 hospitalized children with pathological jaundice were included. Based on their medical conditions, they were categorized into two groups, hemolytic (67 cases) and non-hemolytic (70 cases). Pearson linear correlation and binary logistic multivariate analysis were used to analyze LDH, γ-GT, RET% and hemolysis. Furthermore, the predictive value of the combined predictors of RET%, LDH, and γ-GT on ABO neonatal hemolytic disease was evaluated using the ROC curve analysis. The laboratory indexes of the two groups were subject to analysis using binary logistic regression to identify suspicious influencing factors. The study revealed that RET%, LDH, and γ-GT were independent risk factors for hemolysis. Pearson linear correlation analysis indicated a positive correlation between LDH and γ-GT with RET% (r = 0.529, P < 0.01; r = 0.526, P = <0.01, respectively). Furthermore, the predictive value of each combined predictor was obtained using the ROC curve, and it was observed that combined predictor L (RET% + LDH + γ-GT)>L1 (RET% + LDH)>L2 (RET% + γ-GT). Combined predictor L (RET% + LDH + γ-GT)demonstrate its optimal diagnostic efficacy, offering a novel approach towards diagnosing early-onset ABO hemolytic disease of the newborn.

A Case Report on Congenital Biliary Atresia with Ventricular Septal Defect

Biliary atresia, an obstructive cholangiopathy with an idiopathic etiology, is a congenital disorder that eventually destroys liver parenchyma. In some circumstances, it is associated with other abnormalities such as congenital heart diseases, intestinal, and spleen anomalies. Diagnosis of biliary atresia is based on clinical manifestations and specific diagnostic tests. Prolonged pathological jaundice is a critically important sign in newborns that needs to be recognized early in order to reduce the chances of further complications. The mainstay of treatment is the Kasai procedure (portoenterostomy), and it is eighty percent successful if performed before or within the first two months of life.Here, we report a case of a two-month-old baby who had biliary atresia with a ventricular septal defect (VSD). The baby had a prolonged history of jaundice, pruritus, yellow-colored urine, and pale stools. He was initially brought to a local clinic for his jaundice, where pharmacological treatment was commenced. However, the symptoms persisted, and he was referred to a hospital where he was placed under blue light phototherapy with no marked improvement in his symptoms. For a definite diagnosis and treatment, he was then referred to a multispecialty hospital where diagnostic tests were ordered. The HIDA scan showed no uptake of contrast in the bile ducts and gallbladder, which is suggestive of congenital biliary atresia. An intraoperative cholangiogram showed a definite diagnosis of biliary atresia, which was performed, and the Kasai procedure was done successfully. All his family members were healthy with no history of congenital disease.The essential outcome in this case is to consider biliary atresia as a cause of prolonged jaundice in infants, and occasionally it is associated with other congenital anomalies. The diagnosis and treatment should be urgent in order to prevent complications.

Variation in Hyperbilirubinemia Levels of Male and Female Newborns in Physiological Jaundice: A Retrospective Study

Physiological jaundice is the most common condition that requires medical attention and hospital readmission of neonates. About 60% of term and 80% of preterm babies develop jaundice in the first week of life. Furthermore, about 10% of breastfed babies stay with jaundice until the age of 1 month. In the current study, a total of 139 neonates were evaluated for physiological jaundice in which 89 (64%) were male neonates and 50 (36%) were female neonates. Blood samples were collected under aseptic conditions. All samples were performed on Roche/Hitachi COBASc, based on the spectrophotometric technique. The mean SD (15.867±5.57) was calculated for the total, direct, and indirect bilirubin in neonates who were divided into 3 groups based on the number of days, that is, 1-2, 3-5, and 6-22 days, respectively. For indirect bilirubin in the age group of 1-2, ±SD was 13.80±5.41 in males, whereas it was ±10.40 in females, while the p-value &lt; 0.01 was significant. Hyperbilirubinemia is associated with bilirubin due to a higher mass of red blood cells. It was found that the total, direct, and indirect bilirubin significantly increased in the 1st to 5th day of life after birth with male neonates being more vulnerable to pathological jaundice as compared to female neonates.

Prevalence of Neonatal Hyperbilirubinemia Based on Mother's and Infant's Blood Group in Cengkareng Hospital

Hyperbilirubinemia is an increase in bilirubin levels &gt;5 mg/dL which is characterized by the appearance of pathological jaundice. In the 2017 SKDI, the neonatal mortality rate was 19 per 1000 live births. The purpose of this study was to find out the prevalence of neonatal hyperbilirubinemia based on the blood group of the mother and the baby at Cengkareng General Hospital for the period January to March 2023. This research was conducted from January to March 2023 with an observational descriptive nature. This research was conducted at Cengkareng Hospital, West Jakarta. The study concluded that ABO incompatibility is not the only factor that contributes to hyperbilirubinemia in neonates. The results showed that 15 (41.7%) babies with hyperbilirubinemia came from mothers with blood type O, while the majority of babies who experienced hyperbilirubinemia were babies with blood type O, namely 16 (44.4%) babies. The majority of infants who experienced hyperbilirubinemia occurred in infants with blood group O and mothers with blood type O, namely 11 (30.6%), followed by infants with blood group A and mothers with blood type A, namely 4 (11.1%).

Season of birth and neonatal jaundice

Neonatal jaundice (NJ) is a multifactorial condition specific to the neonatal age. Clinical experience shows that seasons of the year influence the frequency and severity of NJ. Objective: To investigate the influence of annual seasons on the frequency and severity of NJ. Material and methods: The study was conducted at the Neonatology Department of University Hospital "Medica Ruse" with 566 full-term newborns. The follow-up of NJ was carried out with transcutaneous bilirubinometry. The newborns are residents of Ruse region, Republic of Bulgaria. Results: We found a significant difference in bilirubin (BR) levels depending on the season of birth during the early neonatal period. Summer-borns had the highest average levels, followed by spring-borns, and autumn-borns had the lowest. Вorn in the spring had significantly high levels of BR at the end of neonatal period. Climatic factors average and maximum monthly temperature, average monthly rainfall and monthly sunshine duration had a significant influence on the levels of bilirubin on Day 4 (p=0.014), Day 5 (p=0.016) and Day 14 (p=0.004). Prolonged NJ is most commonly observed in summer-borns (p&lt;0.001). Conclusion: Birth season along with meteorological factors affects the frequency of pathological neonatal jaundice.

The need for neonatal jaundice screening awareness in the Pakistani population: short communication.

Neonatal jaundice is a common illness that affects around 80% of preterm and 50-60% of full-term newborn infants. It is one of the most common causes of neonatal death. Neonatal jaundice may be physiological or pathological. Physiologic jaundice is far more common than pathologic jaundice and accounts for most hyperbilirubinemia. Physiologic jaundice in neonates is due to greater hemoglobin breakdown compared to bilirubin clearance. While pathological jaundice occurs due to various infections, drug toxicity, inborn enzyme deficiencies, Rhesus fetal-maternal incompatibility, hypothyroidism, and congenital biliary duct obstruction diseases. In many parts of the world, midwives, and nurses perform spontaneous vaginal deliveries and they only rely on visual screening for neonatal jaundice. However, this is not reliable, especially for newborns having darker skin. Educating the mothers on screening for early detection of neonatal jaundice and seeking medical treatment in a country like Pakistan, which is considered a high-risk population, is crucial. Also, as most females give birth at home, hence, midwives' knowledge about neonatal jaundice also needs to be improved.

Assessment of the therapeutic effect of probiotics combined with intermittent blue light irradiation on pathological jaundice in neonates.

Assessment of the therapeutic effect of probiotics combined with intermittent blue light irradiation on pathological jaundice in neonates.

The Burden of Pathological Neonatal Jaundice and Its Determinants in Ethiopia: Systematic Review and Meta-Analysis

Background Neonatal hyperbilirubinemia is a common clinical problem encountered during the neonatal period, especially in the first week of life. Available clinical guidelines note that early detection and intervention of infants at risk of severe hyperbilirubinemia can facilitate timely and effective prevention of the associated complications. Methods The international databases, PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, Science Direct, and Cochrane Library, and unpublished reports were systematically searched. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was employed to analyze the data. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity between the studies. A random-effect model was computed to estimate the pooled prevalence of pathological neonatal hyperbilirubinemia in Ethiopia. Determinants of neonatal hyperbilirubinemia were analyzed. Results Ten studies fulfilled the inclusion criteria and were included in the meta-analysis. The I2 test result showed high heterogeneity (I2, 98.3%, P = &lt;.001). Using the random effect analysis, the pooled prevalence of neonatal hyperbilirubinemia in Ethiopia was 35.90% (95% confidence interval [CI] [23.79, 48.01]). The results from these studies revealed that the occurrence of pathological neonatal hyperbilirubinemia was significantly associated with the presence of ABO blood incompatibility, Rh isoimmunization, neonatal sepsis (odds ratio [OR]: 4.44; CI: 1.72,11.46), birth asphyxia (OR:1.74; CI: 1.08,2.80), low birth weight (OR: 2.22; CI: 1.46,3.31), and prolonged labor (OR: 3.24; CI: 1.05,10.0). Conclusion The burden of neonatal hyperbilirubinemia is higher in our country as compared with others. ABO blood incompatibility, Rh isoimmunization, neonatal sepsis, birth asphyxia, low birth weight, and prolonged labor were significantly associated with neonatal hyperbilirubinemia.

Study on the value of KMC combined with blue light irradiation in improving the therapeutic effect of neonatal jaundice

ABSTRACT Neonatal jaundice is a common problem that affects newborns. We aim to investigate the effect of Kangaroo Mother Care (KMC) combined with blue-light irradiation on enhancing the therapeutic effect in the treatment of neonatal jaundice. From May 2020 to August 2022, 89 neonates with pathological jaundice and their mothers were selected as participants. All neonates received blue-light irradiation. The participants were divided into two groups: 46 neonates cared for by KMC as the research group (RG) and 43 neonates receiving routine nursing as the control group (CG). The first lactation time, first breastfeeding duration, and scores of Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) before and after nursing were recorded and compared between the groups. Pre- and post-interventional total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels of both groups of newborns were measured, and the time of jaundice resolution, first defecation, and meconium yellowing were recorded. Neonatal adverse reactions (ARs) during treatment were counted, and a nursing satisfaction survey was conducted at discharge. KMC group mothers had earlier lactation and longer first breastfeeding durations (P < 0.05). Both groups’ SAS and SDS scores decreased post-nursing, with greater improvement in the KMC group (P < 0.05). KMC group newborns had lower bilirubin levels and faster resolution of jaundice and meconium yellowing, with fewer adverse reactions and higher nursing satisfaction (P < 0.05). KMC can effectively improve the efficacy of blue light irradiation in the treatment of neonatal jaundice, and promote the healthy development of newborns and the efficiency of maternal breastfeeding.

Effects of bilirubin on the development and electrical activity of neural circuits.

In the past several decades, bilirubin has attracted great attention for central nervous system (CNS) toxicity in some pathological conditions with severely elevated bilirubin levels. CNS function relies on the structural and functional integrity of neural circuits, which are large and complex electrochemical networks. Neural circuits develop from the proliferation and differentiation of neural stem cells, followed by dendritic and axonal arborization, myelination, and synapse formation. The circuits are immature, but robustly developing, during the neonatal period. It is at the same time that physiological or pathological jaundice occurs. The present review comprehensively discusses the effects of bilirubin on the development and electrical activity of neural circuits to provide a systematic understanding of the underlying mechanisms of bilirubin-induced acute neurotoxicity and chronic neurodevelopmental disorders.

The relationship between gut microbiota and neonatal pathologic jaundice: A pilot case-control study.

Neonatal jaundice is a common clinical disease in neonates. Pathologic jaundice is more harmful to neonates. There are a few studies on the biomarkers of pathologic jaundice and the correlation between gut microbiota and clinical indices. Therefore, we aimed to reveal the characteristics of gut microbiota in pathologic jaundice, provide potential biomarkers for the diagnosis of pathologic jaundice, and find the correlation between gut microbiota and clinical indices. Fourteen neonates with physiologic jaundice were recruited into a control group (Group A). Additionally, 14 neonates with pathologic jaundice were recruited into a case group (Group B). The microbial communities were analyzed using 16S rDNA sequencing. LEfSe and the differences in the relative abundance of gut microbiota were used to identify different bacteria among the two groups. The ROC curve was used to assess effective biomarkers for pathologic jaundice. Spearman's rank-sum correlation coefficient was used to evaluate the correlation between gut microbiota and clinical indices. There were no differences in the total richness or diversity of gut microbiota between the two groups. At the phylum and genus levels, compared with the control group, Bacteroidetes (p = 0.002) and Braydrhizobium (p = 0.01) were significantly higher, while Actinobacteria (p = 0.003) and Bidfldobacterium (p = 0.016) were significantly lower in the case group. Bacteroidetes were valuable in differentiating pathologic jaundice from physiologic jaundice by the ROC curve, and the area under the ROC curve (AUC) value was 0.839 [95%CI (0.648-0.995)]. In the case group, Bacteroidetes were negatively associated with total bilirubin (TBIL) (p < 0.05). In the control group, Bacteroidetes were positively associated with TBIL (p < 0.05). Bacteroidetes could be used as biomarkers to identify pathologic jaundice and Bacteroidetes are positively associated with bilirubin levels.

Maternal blood parameters and risk of neonatal pathological jaundice: a retrospective study

This study aims to investigate the association between maternal blood parameters and the risk of neonatal pathological jaundice. A retrospective case–control study of 1309 newborns and their mothers from 2019 to 2020 in a single-center tertiary hospital. All mothers received a complete routine blood test prior to delivery, and outcome was neonatal pathological jaundice. We performed stepwise logistic regression modeling to identify maternal blood factors associated with neonatal pathological jaundice. 258 neonates (19.71%) were diagnosed with pathological jaundice. Logistic regression results showed that the odds ratio for pathological jaundice in neonates of mothers with high white blood cell (WBC) count was 1.512 (95% CI 1.145–1.998; P = 0.004). Besides, neonates whose mothers had a high mean corpuscular volume (MCV) during pregnancy doubled the odds of developing pathological jaundice (OR = 1.967; 95% CI 1.043–3.711; P = 0.037). Among neonates, those whose mothers had high levels of WBC count and MCV were at increased risk of pathological jaundice. Regular obstetric examinations and routine blood tests are essential to initiate adapted care.

The application value of mean red blood cell volume and red blood cell volume distribution width combined with total serum bilirubin in the early screening of neonatal hemolytic disease

BackgroundThe hemolytic nature of hemolytic disease of the newborn (HDN) is described as the abnormal destruction and decomposition of red blood cells, causing heterogeneous manifestations such as abnormal red blood cell volume and morphology. Mean corpuscular volume (MCV) and red blood cell volume distribution width (RDW) are commonly used parameters related to red blood cell volume. Total serum bilirubin (TSB) is routinely monitored among newborns. This study aims to explore the value of MCV and RDW, combined with TSB, to improve the efficiency of HDN diagnosis.MethodsThree hundred eighty-eight children with HDN and 371 children with non-HDN pathological jaundice who were diagnosed and treated in the neonatal department of our hospital from January 2019 to December 2020 were included in the study. Clinical data collected include examination results of laboratory indicators, such as MCV, coefficient of variation of red blood cell volume distribution width (RDW-CV), standard deviation of red blood cell volume distribution width (RDW-SD), and TSB. The differences in the indicators between the two groups of children were retrospectively analyzed.Results1) The detection rate of HDN in children in the early group was higher than that in the late group (P < 0.001). 2) The early-stage group had lower TSB levels and higher values of MCV, RDW-CV and RDW-SD (P < 0.001). Compared with the children in the non-HDN group, the indices in the HDN group were higher in the early stage (P < 0.001). 3) In the early stage, the TSB, MCV, RDW-CV, and RDW-SD were positively correlated with the diagnosis of HDN (P < 0.001). Early monitoring of TSB, MCV, RDW-CV and RDW-SD was valuable for HDN detection, the area under the curve (AUC) was 0.729, 0.637, 0.715, and 0.685, respectively (P < 0.001). 4) After a binary logistic analysis at TSB > 163.3 μmol/L, MCV > 96.35fL, and RDW-CV > 16.05%, the diagnosis rate of HDN increased (P < 0.001). The AUC of the HDN detected using the combined indicators was 0.841.ConclusionAt MCV > 96.35fL or RDW-CV > 16.05%, children with jaundice in three days of birth (especially children with TSB > 163.3 μmol/L) should be screened for HDN. A combination of TSB, MCV, and RDW-CV can improve the early detection rate of HDN, contribute to reduce the readmission rate and risk of hyperbilirubinemia.