Value of the Direct Antiglobulin Test in Predicting the Need for Phototherapy in Newborns

Abstract

Purpose

Guidelines for managing neonatal hemolytic disease of the newborn (HDN) recommend a selective approach in the use of direct antiglobulin test (DAT). In Saudi Arabia, many hospitals still perform routine DAT for all newborns. This study assessed the need for phototherapy in relation to DAT results in full-term healthy newborns.

Patients and Methods

A retrospective analysis of all healthy newborns admitted during 2018 was performed. The primary outcome was the association of positive DAT results with phototherapy.

Results

There were 1463 newborns born during the study period. The DAT was positive at 4.4%. The 24-hour bilirubin levels were higher in DAT-positive cases (P=0.06); however, peak bilirubin levels were not correlated with the DAT results (P=0.717). Thirty-six neonates (2.46%) required phototherapy, and the need was similar among DAT-positive and DAT-negative cases (P=0.271). The most common indication for phototherapy was clinical jaundice in 22 neonates (61.1%), followed by DAT positivity in 12 (33.3%) and hospital protocol in 2 patients (5.6%) (P <0.01 by chi-square overall comparison).

Conclusion

Our results indicate that factors other than DAT positivity are important in assessing the need for phototherapy in newborns. Clinical signs of jaundice were indicators of high serum bilirubin levels and subsequent phototherapy, further indicating that the DAT test was overused in predicting the need for phototherapy.

Keywords:

• hemolytic disease of the newborn
• neonatal jaundice
• neonatology
• screening

Abbreviations

DAT, direct antiglobulin test; NICE, National Institute for Health and Clinical Excellence; HDN, hemolytic disease of the newborn; RBC, red blood cells; NICU, neonatal intensive care.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

The study was approved by the University Institutional Review Board (lRB) and Ethical Committee (lRB UGS‐2019‐01‐349). This is a retrospective study conducted on electronic records of patients with no patient identity being disclosed. Therefore, informed consent was not applicable. This study was conducted in accordance with the Declaration of Helsinki.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

No funding sources.