A retrospective comparison of phototherapy need in O-B versus O-A incompatibility in a single Saudi institution.

BACKGROUND: ABO incompatibility is a major risk factor for neonatal indirect hyperbilirubinemia (NIH), requiring treatment. It has been shown that there are racial differences in direct antiglobulin test (DAT) positivity and phototherapy need in the O--B versus (vs) O--A incompatibility. The comparison between the O--B and O--A incompatibility is not well studied in Saudi Arabia. AIMS: We aimed to compare DAT positivity and phototherapy need in O-B vs O-A incompatibility in Saudi Arabia. METHODS: This retrospective cohort study was conducted in one Saudi hospital. We included a convenience sample of neonates born between 01 January 2013 and 31 December 2021. We included healthy neonates admitted to the nursery care unit only, born at≥38 weeks gestation, and had normal G6PD levels. Neonates that had no G6PD level measurement or lost follow-up post-discharge were excluded. The data span was the first 14 days of life. RESULTS: A total of 611 neonates met our inclusion criteria. Positive DAT was more prevalent in the O-B than the O-A incompatibility [43.5% vs 29.2%, p < 0.001). A greater odd of phototherapy need was observed in the O--B vs O-A incompatibility across various strata. Readmission for NIH, use of 360° exposure phototherapy, or intravenous immunoglobulin administration was more prevalent in the O-B than the O-A incompatibility (13.2% vs 5.0%, p < 0.001). A logistic regression analysis revealed that the O-B incompatibility modified the association between DAT positivity and phototherapy need. CONCLUSIONS: The O-B incompatibility had a mediator effect on the relationship between DAT positivity and the need for phototherapy in the study population, which emphasizes that the O-B and O-A are not the same from the NIH point of view.

Selective prophylactic solvent-detergent plasma and cryoprecipitate transfusion to prevent intraventricular hemorrhage in extreme preterm infants: A case-historical control.

BACKGROUND: Contradictory evidence exists whether a prophylactic coagulation factor transfusion in the first hours of life (HOL) prevents intraventricular hemorrhage (IVH) in extreme preterm infants (EPI, <28 weeks gestation). We aimed to determine whether selective prophylactic solvent-detergent plasma and cryoprecipitate transfusion within 12 hours of life (SP-SDP/Cryoprecipitate-T) could prevent IVH in EPI. METHOD: This is a retrospective analysis, case-historical control, of prospectively collected data from a pre-existing electronic neonatal database at a Saudi tertiary neonatal intensive care unit. We compared the IVH rate in EPI born in the first 4 years (Jan 2010-Dec 2013) of the SP-SDP/Cryoprecipitate-T period with that of EPI born during the last 4 years (Jan 2006-Dec 2009) of the rescue SDP/Cryoprecipitate-T period. RESULTS: The IVH rate was lower in the SP compared to the rescue- SDP/Cryoprecipitate-T period (30.8% versus 51.2%, odds ratio 0.42, 95% confidence interval 0.21, 0.88, p = 0.02). This difference remained significant after controlling for six other IVH risk factors. CONCLUSIONS: Early SP-SDP/Cryoprecipitate-T may reduce the IVH rate in EPI. A large multicenter clinical trial is required for confirm the short and long-term benefit and risk of this intervention. Until then, early SP-SDP/Cryoprecipitate-T may be considered by an institution with a persistently high IVH rate.

Readmission for neonatal hyperbilirubinemia in an area with a high prevalence of glucose-6-phosphate dehydrogenase deficiency: A hospital-based retrospective study.

BACKGROUND: Hyperbilirubinemia is one of the most common causes of neonatal readmission to hospital. AIMS: To assess risk factors for hyperbilirubinemia among neonates readmitted for this condition and the ratio of the mean corpuscular hemoglobin concentration (MCHC) to the mean corpuscular volume (MCV). METHODS: We retrospectively studied the clinical and laboratory findings, management and possible risk factors for hyperbilirubinemia in 301 neonates born at ≥35 weeks gestation and readmitted to hospital owing to hyperbilirubinemia over five years. RESULTS: No risk factors for hyperbilirubinemia were identified in 64 (21.3%) neonates, and one or more risk factors were found in 237 neonates (78.7%). The most prevalent risk factor (41.9%) was G6PD deficiency, which occurred in 11 of the 15 neonates with a serum bilirubin level ≥427 µmol/l. A double-volume exchange blood transfusion was performed in two neonate boys in whom G6PD deficiency was the single risk factor for hyperbilirubinemia. One of them developed kernicterus later. The MCHC/MCV ratio of neonates with idiopathic hyperbilirubinemia, unexplained hemolysis, or other risk factors overlapped. CONCLUSIONS: This study confirmed that in an area where G6PD deficiency is prevalent, it is the most common and most severe risk factor for hyperbilirubinemia. This finding supports routine neonatal screening for G6PD deficiency in such areas. The usefulness of determining the MCHC/MCV ratio in the management of hyperbilirubinemia is uncertain.