Fatih Mehmet KIŞLAL, Nilgün ALTUNTAŞ, Sibel AKPINAR TEKGÜNDÜZ, Burcu ÖZKAN KIRGIN, Özlem Ceylan DOĞAN

AB0 Uygunsuzluğuna Bağlı Hiperbilirubinemili Yenidoğanlarda Fototerapi Gereksinimi Öngörülebilir mi?

Amaç: Çalışmada, AB0 uygunsuzluğuna bağlı indirekt hiperbilirubinemi (İHB) gelişen yenidoğanlarda, fototerapi gereksinimini ilk gün saptayabilecek belirteçler araştırıldı.Gereç ve Yöntemler: Anne-bebek arasında AB0 uygunsuzluğu olan, zamanında doğmuş, ek hastalığı olmayan sağlıklıyenidoğanlar ileriye dönük izlem amacıyla çalışmaya alındı. Olguların ilk 6. ve 24. saatlerinde hemoglobin (Hgb), bilirubinve laktat dehidrogenaz (LDH) düzeylerine bakıldı. Olguların ilk 15 gün Bhutani nomogramına uygun sıklıkta serum bilirubin düzeyleri takip edildi ve fototerapi gereksinimi Amerikan Pediatri Akademisi’nin önerdiği sınırlar kullanılarak belirlendi.Fototerapi sınırını geçerek fototerapi uygulanan bebeklerle, fototerapi sınırının altında kalanların sonuçları karşılaştırıldı.Bulgular: AB0 uygunsuzluğu nedeniyle çalışmaya alınan 83 bebekten 18’inde B0 (%21.7), 65’inde (%78.3) A0 uygunsuzluğu saptandı. Bebeklerin 44’ünde (%53) direkt antiglobulin testi (DAT) pozitifti. DAT pozitif olan yenidoğanların13’ü (%33.3), DAT negatif olanların ise 12’si (%27.3) izlemde İHB nedeniyle fototerapi aldı. İki grup arasında yatış sıklığıaçısından anlamlı fark yoktu (p=0.58).İndirekt hiperbilirubinemi nedeniyle fototerapi uygulanan ve uygulanmayan gruplar arasında 6. ve 24. saat Hgb ile LDHdüzeyleri arasında anlamlı fark saptanmadı (p>0.05). Ancak, fototerapi gereksinimi olan hiperbilirubinemili bebeklerde24. saat bilirubin düzeyleri, fototerapi ihtiyacı olmayanlara göre daha yüksek bulundu (p=0.03).Sonuç: Yenidoğanlarda AB0 uygunsuzluğuna bağlı İHB nedeniyle fototerapi gereksiniminin belirlenmesinde, 24. saatHgb, DAT ve LDH düzeylerinin prediktif değeri yoktur, ancak 24. saat bilirubin düzeyi prediktif olabilir. AB0 uygunsuzluğuna bağlı hemolitik hastalık spektrumunun geniş olması nedeniyle, AB0 uygunsuzluğu olan yenidoğanların yakınizlenmeleri gerektiği düşünülmüştür.

Is the Phototherapy Requirement in Neonatal Hyperbilirubinemia due to AB0 Incompatibility Predictable?

Objective: We aimed to investigate whether there is any predictive marker on the first day for the prediction of infants requiring phototherapy due to AB0 incompatibility associated neonatal hyperbilirubinemia. Material and Methods: Full term healthy newborns with AB0 incompatibility were included. Hemoglobin (Hgb), bilirubin, and lactate dehydrogenase (LDH) values were recorded at the first 6th and 24th hours of the infants. The infants were monitored according to the Bhutani nomogram during the first 15 days. The infants who were applied phototherapy due to indirect hyperbilirubinemia (IHB) were recorded. We compared the infants who received and did not receive phototherapy. Results: Among 83 term newborns with AB0 incompatibility, there were 18 infants with B0 (21.6%) and 65 infants (78.3%) with A0 incompatibility. The direct antiglobin test (DAT) was positive in 44 (53%) infants. There were 13 DAT positive (33.3%) and 12 DAT negative (27.3%) infants treated with phototherapy due to IHB. There was no significant difference in the incidence of hospitalization between the two groups (p=0.58). There was no significant difference between the first 6th and 24th hour Hgb and LDH levels between the groups (p>0.05). However, bilirubin levels at the 24th hour of life were found to be higher in the infants that received phototherapy (p=0.03). Conclusion: It was concluded that Hgb, DAT and LDH values in the first 24 hours of life in the newborns with IHB due to AB0 incompatibility were not predictive for the phototherapy requirement. However, bilirubin levels at the 24th hour of life could be valuable. We considered that close follow-up of newborns with AB0 incompatibility could be appropriate due to the broad spectrum of the disease.

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