الفهرس 
NEONATAL JAUNDICEيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
COHb is a sensitive index of bilirubin production and is thus a useful parameter to assess hemolysis. The rate of CO production can be estimated using a variety of techniques. Measuring COHb with a conventional blood gas CO-oximeter is simple, and the device is readily available in most institutions and could be useful in routine clinical practice.
The aim of the current study was to assess whether the non-invasive COHb measurement could be used as an indicator of hemolysis in newborns due to ABO, Rh alloimmunization.
This prospective study was conducted on 120 jaundiced neonates divided into 4 groups: 30 patient diagnosed with ABO hemolytic jaundice (group 1), 30 patient with Rh hemolytic jaundice (group 2), 30 patient with non-hemolytic jaundice (group 3) and 30 with normal physiological jaundice below level of intervention (group 4).
On investigating the maternal risk factors in the current study, The difference between the study groups according to previous blood transfusion was statistically significant (P<0.001).
There was no significant difference between the studied groups as regards the maternal history of previous siblings’ admission for jaundice. Among this study population the difference between the studied groups regarding PROM was statistically significant (P= p=0.002).
66.7% of patients diagnosed with ABO hemolytic jaundice in this study (group 1) delivered vaginally and 33.3% delivered via cesarean section. In Rh hemolytic jaundice patients (group 2) 36.7% delivered vaginally and 63.3% delivered via cesarean section. 70% of non-hemolytic jaundice patients (group 3) delivered via cesarean section. 63.3% of normal physiological jaundice neonates (group 4) delivered via cesarean section. The difference was statistically significant (P=0.01).
Obstructed labour was reported in 13.3% of Rh hemolytic jaundice patients (group 2) and in 10% of non-hemolytic jaundice patients (group 3). It didn’t occur in neither group 1 nor group 4. The difference was non-significant. Instrumental delivery was reported in 6.7% of non-hemolytic jaundice patients (group 3). There was non-significant difference between the study groups.
The mean gestational age in this study groups was 38.10±0.71weeks, 37.97±0.76 weeks, 38.13±0.68 weeks and 38.13±0.63 weeks in group 1 (ABO hemolytic), 2 (Rh hemolytic), 3 (non- hemolytic) and 4 (normal physiological). There was non-significant difference between the study groups.
The mean APGAR score at 1 minute and 5 minutes in group 1 were 7.73±0.45 and 9.47±.51, respectively. In group 2 the mean APGAR score at 1 minute and 5 minutes were 7.73±0.74 and 9.47±0.51, respectively. In group 3 they were 7.50±0.68 and 9.50±0.51, respectively, and in group 4 they were 7.53±0.63 and 9.37±0.49, respectively. The differences were non- significant.
The mean weight in the studied groups was 3477.67±75.28 g, 3466±96.15 g, 3460±89.44 g and 3481.67±86.59 g in group 1, 2, 3 and 4, respectively. The mean length in group 1 was 49.50±1.19 cm, in group 2 was 49.37±1.27 cm, in group 3 was 49.77±1.19 cm and in group 4 it was 49.27±1.34, respectively. The differences were non- significant.
Jaundice was found in all group 2, 3 and 4 cases. No jaundice detected among group 1 patients. All the patients in the 4 study groups had a stable temperature. In the four study groups no birth injury, brusies, cyanosis, pallor, splenomegaly or hepatomegaly were detected.
Fetal blood groups were A, AB, B and O in 40%, 13.3%, 43.3%, and 3.3% in group (1). In group (2) 50% of the patients had blood group A, 13.3% had AB, 33.3% had group B and 3.3% had blood group O. 53.3% of group (3) patients had blood group A and 46.7% had blood group B. In group (4) 50%, 10% and 40 of the patients had blood groups A, AB and B. The difference between the study groups was non-significant.
In this study there was statistically significant difference between the four groups as regards the maternal blood groups (P<0.001). Among mothers of neonates with ABO incompatibility jaundice (group 1) the most frequently found blood group was A (50%). The most frequently found blood group in mothers of group 2 (neonates with ABO incompatibility jaundice) was B. While, all group 3 mothers (non-hemolytic jaundice neonates) mothers had blood group O. Among mothers of neonates with normal physiological jaundice (group 4) blood group A and B were found equal (40%).
Rh of the mothers of group 1, 2, and 3 patients in this study was positive. All group 4 mothers were Rh negative.
The mean hematocrit value was 54.58±2.86, 55.15±2.61, 44.28±2.80 and 45.41±2.58 in groups 1, 2, 3 and 4, respectively. The difference was statistically significant (P<0.001).
In this study the mean hemoglobin level was 18.49±0.78 gm/dl, 18.54±0.79 g/dl, 14.46±0.77 gm/dl and 14.07±0.76 gm/dl in groups 1, 2, 3 and 4, respectively. The difference was statistically significant (P<0.001).
Total leukocyte count was 16.94±3.05, 15.18±4.02, 14.06±3.19 and 18.36±3.84 in groups 1, 2, 3 and 4, respectively. The difference was statistically significant (P<0.001).
According to this study findings mean platelet count was 214.77±31.89, 299.03±64.68, 329.37±64.10 and 252.97±31.94 in groups 1, 2, 3 and 4, respectively. The difference was statistically significant (P<0.001).
In the current study neutrophil Count was 8.30±2.35, 9.68±3.01, 9.79±2.68 and 9.68±3.0 in groups 1, 2, 3 and 4, respectively. The difference was non-significant (P=0.123).
In group (1) the total serum bilirubin and direct bilirubin levels were 0.453±0.187 mg/dl and 0.167±0.095 mg/dl. In group (2) they were 3.21±0.70 mg/dl and 0.207±0.094 mg/dl. In group (3) 8.29±0.89 mg/dl and 0.347±0.094 mg/dl. In group (4) they were 8.63±0.65 mg/dl and 0.343±0.089 mg/dl, respectively. The differences between the two groups were statistically significant (P<0.001).
Reticulocytes% and CRP were 2.81±0.69 and 3.17±1.51 mg/dl in group (1), 2.90±0.72 and 6.81±1.03 mg/dl in group (2), 4.76±0.23 and 3.65±1.12 Mg/dl in group (3) and in group (4) they were 4.72±0.26 and 4.06±0.65 mg/dl, respectively. The differences between the two groups were statistically significant (P<0.001).
The differences between the four groups as regards the mean ALT level and LDH level were statistically significant (P<0.001).
Indirect coombs was negative in 100% of group 1, 2 and 3 patients. In group (4) it was negative in 80% and positive in 20% of the patients.
On Comparison of COHB RAD-17 CO-oximeter between studied groups, it was found that COHB RAD-17 CO-oximeter in neonates subjected to risk factors in the context of ABO incompatibility (group 1) at 0 hours 4.73±1.2. In group 2 (Neonates subjected to risk factors in the context of Rh incompatibility) COHB RAD-17 CO-oximeter at 0 hours was 5.73±0.87, at 12 hours it was 3.89±1.11, at 24 hours it was 2.10±1.01 and at 36 hours it was 1.48±0.68.
In group 3 (Neonates with hyperbilirubinemia without hemolysis) COHB RAD-17 CO-oximeter at 0 hours was 10.97±0.96, at 12 hours it was 8.53±0.82, at 24 hours it was 6.43±1.13, at 36 hours it was 3.43±0.86, at 48 hours it was 2.37±0.56 and at 60hours it was 1.47±0.68.
In group 4 (Neonates with normal physiological jaundice below level of intervention) COHB RAD-17 CO-oximeter was 10.90±0.96, 9.47±1.19, 7.90±0.88, 6.57±0.94, 4.87±0.73, 3.93±0.78, 2.43±0.935 and 1.87±0.68 at 0 hours, 12 hours, 24 hours, 36 hours, 48 hours, 60 hours, 72 hours and 84 hours, respectively.
The differences between the four groups as regards COHB RAD-17 CO-oximeter were statistically significant (P<0.001).
In the current study groups total bilirubin level at 0 hours was 3.19±0.69, 8.29±0.89 and 8.63±0.64 in group 2 (Neonates subjected to risk factors in the context of Rh incompatibility), group 3 (Neonates with hyperbilirubinemia without hemolysis) and group 4 (Neonates with normal physiological jaundice below level of intervention), respectively.
At 12hours it was 2.11±0.54, 7.47±0.76 and 7.60±0.73 in group 2, 3 and 4, respectively. At 24 hours total bilirubin level was 0.83±0.18, 5.96±0.94 and 6.35±0.98 in groups 2, 3 and 4, respectively.
At 36 hours it was 3.61±0.83 and 5.30±0.96 in groups 3 and 4, respectively. At 48 hours it was 2.06±0.48 and 4.10±1.06 in groups 3 and 4, respectively. At 72 hours it was 0.80±0.21 and 2.66±1.12 in groups 3 and 4, respectively. At 84 hours total bilirubin level was 0.787±0.23 in group 4. The differences were statistically significant (P<0.001).
In the current study groups direct bilirubin level at 0 hours was 0.211±0.08, not detected and 0.25±0.07 in group 2 (Neonates subjected to risk factors in the context of Rh incompatibility), group 3 (Neonates with hyperbilirubinemia without hemolysis) and group 4 (Neonates with normal physiological jaundice below level of intervention), respectively. The difference was non-significant (p=0.07).
At 12 hours it was 0.210±0.048, 0.330±0.091 and 0.333±0.09 in group 2, 3 and 4, respectively. The difference was statistically significant (p<0.001). At 24 hours direct bilirubin level was 0.173±0.04, 0.253±0.068 and 0.273±0.131 in groups 2, 3 and 4, respectively. The difference was statistically significant (p<0.001). At 36 hours it wasn’t detected in group 2 and 0.250±0.073 and 0.250±0.104 in groups 3 and 4, respectively. The difference was non-significant (p=1.0). At 48 hours it was 0.197±0.041 and 0.233±0.092 in groups 3 and 4, respectively. The difference was non-significant (p=0.052). At 72 hours it was 0.237±0.10 and 0.193±0.058 in groups 3 and 4, respectively. The difference was non-significant (p=0.05). At 84 hours direct bilirubin level was 0.237±0.103 and 0.193±0.058 in group 3 and 4. The differences were non-significant (P=0.05). At 96 hours direct bilirubin level was 0.165±0.048.
The median trans C level in group 1(neonates subjected to risk factors in the context of ABO incompatibility) at 0 hours was 2. In group 2(neonates subjected to risk factors in the context of Rh incompatibility) at 24 hours was 1. In group 3(neonates with hyperbilirubinemia without hemolysis) at 60 hours was 2. In group 4 (neonates with normal physiological jaundice below level of intervention) at 72 hours was 2.
After 48 and 72 hours COHB RAD- 17 CO-oximeter was 8.93±1.41, 2.60±0.81, 3.07±1.01 and 3.33±0.92 in group 1, 2, 3 and 4. The difference was statistically significant (P<0.001).
The transcutaneous bilirubin after 48 and 72 hours was 6.0±1.33, 1.13±0.86, 2.10±0.71 and 2.27±0.64. The difference was statistically significant (P<0.001).
It is concluded that COHb values determined with CO-oximeters are significantly different between neonates subjected with ABO incompatibility, neonates with Rh incompatibility, neonates with hyperbilirubinemia without hemolysis and neonates with normal physiological jaundice below level of intervention. So, non-invasive COHb measurement could be used as an indicator of hemolysis in newborns due to ABO, Rh alloimmunization.
It is recommended that to further evaluate the role of the non-invasive COHb measurement as an indicator of hemolysis in newborns due to ABO, Rh alloimmunization in a larger sample size and for longer study period.