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Maternal serum and cord blood anti-A and Anti-B antibody levels as a predictor of significant hyperbilirubinemia in newborns
Pramod Uttamlal Toshniwal1, Lalitha Krishnan1, Simon Kingsley2, Satish Kurvila3, M Manikandan1
1 Department of Paediatrics and Neonatology, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Pathology and Transfusion Medicine and Obstetrics and Gynaecology, Pondicherry Institute of Medical Sciences, Puducherry, India
3 Department of 2Obstetrics and Gynaecology, Pondicherry Institute of Medical Sciences, Puducherry, India
Correspondence Address:
Simon Kingsley,
No 83, Vaigai Street, Vasantham Nagar, Puducherry - 605 110
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/ajts.ajts_182_21
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BACKGROUND: Hemolytic disease of the newborn (HDN) was more common due to Rh incompatibility. Its prevalence has decreased due to introduction of Immunoglobulin G (IgG) prophylaxis against RhD antigen. HDN due to ABO incompatibility has become more common.
AIM: The aim of this study was to study the predictive value of umbilical cord serum and maternal serum anti-A and anti-B antibody titer for the occurrence of significant hyperbilirubinemia in newborns.
SETTINGS AND DESIGN: This was a prospective cohort study which included 139 “O” blood group mothers and their offspring with A or B blood groups.
MATERIALS AND METHODS: We analyzed the IgG anti-A, and anti-B antibody titers from cord blood and maternal serum and correlated them with features of significant hyperbilirubinemia. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated.
RESULTS: Twenty-eight newborns out of 139 (20 %) developed significant hyperbilirubinemia and required phototherapy. One newborn required immunoglobulin infusion. Out of these 28 newborns' maternal serum, 22 (79%) newborns' maternal serum had IgG antibody titer of ≥128. Cord blood serum IgG antibody titer was 1:2 in all newborns, which was not significant. The direct Coombs test was positive in six (4%) newborns with maternal IgG antibody titer ≥128.
CONCLUSION: Maternal IgG antibody titer was ≥1:128 and can predict significant hyperbilirubinemia in newborns with a sensitivity of 53.5%, specificity of 98.2%, PPV of 88%, NPV of 89%, and P value (P > 0.001).
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