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Summary:
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. Clin Pediatr. 2004;43:63-68
Introduction
Newborn jaundice continues to be one of the most frequent reasons for hospital readmissions of newborn infants.1-5 It is a commonly occurring condition that develops in 60-80% of term or near-term infants during the first week of life. Extremely high serum total bilirubin (STB) concentrations (> or = 30 mg/dL), which occur in approximately 1 in 10,000 infants, can lead to kernicterus, a rare, neurologically devastating condition that can be prevented by early identification and treatment of hyperbilirubinemia.6 The incidence of kernicterus appears to have increased in the 1990s. Unlike those in previous years, many of these cases have occurred, not in infants with ABO or Rh incompatibility, but in apparently healthy term and near-term infants.7,8 Since jaundice is so common and kernicterus is rare, there has been considerable interest in developing a practice parameter to identify infants who are most at risk for developing the severe hyperbilirubincmia that may lead to this complication. Universal predischarge STB testing, measurement of end-tidal carbon monoxide corrected (ETCOc) for inhaled CO and early follow-up within 2 to 3 days of discharge...