Abstract / Summary
Background: ABO incompatibility is one of the leading causes of immune-mediated hemolytic disease in newborns and contributes substantially to the development of neonatal hyperbilirubinemia. Early identification of affected neonates is essential to prevent bilirubin-induced neurological complications. Our objective is to determine the prevalence of ABO incompatibility among term neonates with neonatal jaundice and evaluate its association with immune hemolysis and clinical outcomes. Methods: This descriptive cross-sectional study included 152 term neonates diagnosed with neonatal jaundice at the Department of Pediatric Medicine, Children Hospital, Balochistan Institute of Child Health Services. Neonates with conjugated hyperbilirubinemia, congenital anomalies, syndromic disorders, or metabolic storage diseases were excluded. Clinical and demographic data were collected, and laboratory investigations included maternal and neonatal ABO blood grouping, total, direct, and indirect serum bilirubin measurements, and Direct Coombs Test (DCT). Statistical analyses were performed to determine the association between ABO incompatibility, immune hemolysis, and the requirement for exchange transfusion. Results: The mean age at presentation was 7.55 ± 4.01 days, and the mean gestational age was 38.93 ± 1.22 weeks. The mean total serum bilirubin concentration was 15.93 ± 3.50 mg/dL, with predominantly indirect hyperbilirubinemia (15.06 ± 3.54 mg/dL). ABO incompatibility was identified in 22 of 152 neonates (14.5%). Overall, 78 neonates (51.3%) were DCT positive, and all ABO-incompatible neonates demonstrated positive DCT results, indicating a significant association between ABO incompatibility and immune-mediated hemolysis (p < 0.001). Exchange transfusion was performed in 88 neonates (57.9%), including 16 (72.7%) with ABO incompatibility and 72 (55.4%) without incompatibility; however, this difference did not reach statistical significance (p = 0.197). Conclusion: Early immune-hematological screening using ABO blood grouping and DCT may facilitate timely diagnosis and optimize the clinical management of neonatal jaundice.