Factors Influencing the Severity of Jaundice in Direct Antiglobulin (Coomb's) Test Positive Neonates

Direct Antiglobulin Test (DAT) is a screening method used to identify Hemolytic Diseases of Newborn (HDN). Risk of neonatal jaundice for infants with positive DAT is four times higher than those with negative DAT. However, clinical guidelines regarding the risk factors amongst DAT positive neonates requiring phototherapy are not clear. This study aimed to assess the risk factors that influence the severity of jaundice among DAT positive neonates and its impact on treatment.

A one-year retrospective observational study (2022-2023) which included all DAT- positive newborn babies reported in that period.

In our study period 134 babies had jaundice and were given phototherapy (cases), 19 did not have jaundice (controls). The two groups were compared for strength of DAT, neonatal risk factors such as asphyxia, sepsis, exclusive breast feeding, excess weight loss and maternal risk factors including Indirect Antiglobulin Test (IAT) status. A statistically significant increase in the bilirubin levels from day 1 to day 3 (p value of < 0.05) was observed. Multivariate regression analysis performed showed significant association between the risk factors and neonatal serum bilirubin levels.

In the department of Neonatology, a positive DAT is an indicator to perform bilirubin levels in the newborn and subsequently monitor these levels. DAT also helps to diagnose if blood group mismatches are the reason for the hyperbilirubinemia. This is essential for the management of neonatal jaundice. However, in addition to positive DAT, the presence of other neonatal and maternal risk factors also influences the severity of neonatal hyperbilirubinemia.