Irfan Waheed, Akmal Laeeq Chishti, Arshad Alvi, Azhar Iqbal.
Hemolytic disease of newborn: Can we meet this challenge?.
Pak Paed J Jan ;29(3):129-32.

An observational study was carried out prospectively on the cases admitted primarily with neonatal jaundice in the Department of Neonatology, at the Children`s Hospital & Institute of Child Health Lahore (2002), with the aim to find out and study cases of hemolytic disease of newborn (HDN) and compare them with other case of unconjugated hyperbilirubinemia (Non HDN). Out of 3615 admissions, 400 cases with jaundice were included (11%). The study cases were admitted at mean age of 6.4 days and had mean serum bilirubin level 20.3 mg/dl (range 8-37) at admission. Hemolytic disease of newborn (HDN group) was diagnosed in 82 cases (20.5%) on the basis of reticulocytosis, anemia, rising bilirubin levels in pathological range in the presence of blood group incompatibility, while Non- HDN group comprised of 318 neonates (79.5%). Among HDN group, ABO incompatibility was diagnosed in 58 cases, Rh incompatibility in 19 cases, 5 cases as suspected minor blood group incompatibility (no major incompatibility, normal G6PD status, no membrane defects). Exchange transfusion (ET) was done in 50 cases in HDN group (61%) and kernicterus observed in 11 cases (13.4%). On comparison, ET was required in 45 cases (14%) and kernicterus observed in 27 cases (8.4%) in non HDN group. Cases in HDN group required ET more frequently, and also developed kernicterus more often. Although ABO incompatibility was more prevalent than Rh incompatibility, ET was required more frequently in later group, due to higher bilirubin levels. The current figures regarding neonatal jaunand from a referral neonatal center reflect an unsatisfactory level of care. This strongly suggests preventive efforts directed at antenatal screening during pregnancy (including blood group and presence of anti-D antibodies in mothers etc), early referral of jaundiced neonates, and prompt management of jaundiced neonates at community hospitals.

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