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Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT+ infants

Journal of Perinatology volume 36, pages 386–388 (2016)Cite this article

Subjects

Abstract

Objectives:

To compare the degree of hemolysis in a group of direct antiglobulin test (DAT) positive (pos) African-American (AA) infants as measured by carboxyhemoglobin corrected (COHbc) for carbon monoxide in ambient air to a similar group of DAT negative (neg) ABO incompatible infants and a group without blood group incompatibility. To determine if COHbc is a better predictor of significant hyperbilirubinemia than DAT status.

Study Design:

A prospective study of 180 AA infants from the Well-Baby Nursery of an inner city community hospital, all of whose mothers were type O pos. Infants (60) were ABO incompatible DAT pos, 60 were ABO incompatible DAT neg and 60 were type O+. Blood for COHbc was drawn at the time of the infants’ initial bilirubin and the infants’ precise percentile on the Bhutani nomogram was calculated.

Result:

Mean COHbc of type O+ infants was 0.76±0.21 and 0.78±0.24% for ABO incompatible DAT neg infants (P=0.63). Mean CoHbc for the ABO incompatible DAT pos infants was 1.03±0.41% (P<0.0001 compared with both type O and DAT neg infants). Optimal cutoff on the receiver operating characteristic curve for COHbc to determine the risk for being in the Bhutani curve high risk zone was COHbc >0.90% (area under the curve(AUC) 0.8113). This was similar to the AUC of the receiver operating characteristic curve using any titer strength of DAT pos as a cutoff (0.7960).

Conclusion:

Although not greatly superior to the titer strength of DAT pos, COHbc is useful in determining if the etiology of severe hyperbilirubinemia is a hemolytic process.

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References

  1. Slusher TM, Zipursky A, Bhutani VK . A global need for affordable neonatal jaundice technologies. Semin Perinatol 2011; 35: 185–191.

    Article  Google Scholar 

  2. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297–316.

    Article  Google Scholar 

  3. Bhutani VK, Johnson L, Sivieri EM . Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term infants. Pediatrics 1999; 13: 6–14.

    Article  Google Scholar 

  4. Schutzman DL, Sekhon R, Hundalani S . Hour-specific bilirubin nomogram in infants with ABO incompatibility and direct Coombs-positive results. Arch Pediatr Adolesc Med 2010; 164: 1158–1164.

    Article  Google Scholar 

  5. Kaplan M, Hammerman C, Vreman H, Wong RJ, Stevenson DK . Hemolysis and hyperbilirubinemia in antiglobulin positive, direct ABO blood group heterospecific neonates. J Pediatr 2010; 157: 772–777.

    Article  CAS  Google Scholar 

  6. Sarici SU, Yurdakok M, Serdar MA, Oran O, Erdem G, Tekinalp G et al. An early (sixth hour) serum bilirubin measurement is useful in predicting the development of significant hyperbilirubuinemia and severe ABO hemolytic disease in a selective high-risk population of newborns with ABO incompatibility. Pediatrics 2002; 109: e53–e58.

    Article  Google Scholar 

  7. Kaplan M, Hammerman C, Vremen HJ, Wong RJ, Stevenson DK . Direct antiglobulin titer strength and hyperbilirubinemia. Pediatrics 2014; 134: e1340–e1344.

    Article  Google Scholar 

  8. Lapierre Y, Rigil D, Adam J, Josef D, Meyer F, Gerber S et al. The gel test: a new way to detect red cell antigen-antibody reactions. Transfusion 1990; 30: 109–113.

    Article  CAS  Google Scholar 

  9. Stevenson DK, William A . Silverman lecture. J Perinatol 2014; 34: 1–5.

    Article  CAS  Google Scholar 

  10. Herschel M, Karrison T, Wen M, Caldarelli L, Baron B . Evaluation of the direct antiglobulin (Coombs) test for identifying newborns at risk for hemolysis as determined by end-tidal carbon monoxide concentration (ETCOc); and comparison of the Coombs test with ETCOc for detecting significant jaundice. J Perinatol 2002; 22: 341–347.

    Article  Google Scholar 

  11. Vreman HJ, Stevenson DK . Carboxyhemoglobin determined in neonatal blood with a CO-oximeter unaffected by fetal oxyhemoglobin. Clin Chem 1994; 40: 1522–1527.

    CAS  PubMed  Google Scholar 

  12. Stevenson DK, Fanaroff AA, Maisels MJ, Young BWY, Wong RJ, Vreman HJ et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics 2001; 108: 31–39.

    Article  CAS  Google Scholar 

  13. Herschel M, Karrsion T, Wen M, Caldarelli L, Baron B . Isoimmunization is unlikely to be the cause of hemolysis in ABO-incompatible but direct antiglobulin test negative neonates. Pediatrics 2002; 110: 127–130.

    Article  Google Scholar 

  14. Cohen RS, Wong RJ, Stevenson DK . End-tidal breath carbon monoxide measurements: current directions. NeoReviews 2012; 13: e486–e490.

    Article  Google Scholar 

  15. Kaplan M, Muroca M, Hammerman C, Rubaltelli FF, Vilei MT, Vreman HJ et al. Imbalance between production and conjugation of bilirubin: a fundamental concept in the mechanism of neonatal jaundice. Pediatrics 2002; 110: e47.

    Article  Google Scholar 

  16. Beutler E, Gelbert T, Demina A . Racial variability in the UDP-glucuronosyl-transferase 1 (UGT1A1) promoter: a balanced polymorphism for regulation of bilirubin metabolism. Proc Natl Acad Sci USA 1998; 81: 505–511.

    Google Scholar 

  17. Bhutani VK, Wong R . Bilirubin induced neurologic dysfunction (BIND). Semin Fetal Neonatal Med 2015; 20: 1.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported in part by a grant from The Albert Einstein Society of the Einstein Healthcare Network.

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Authors and Affiliations

  1. Department of Pediatrics and Adolescent Medicine, Einstein Medical Center, Philadelphia, PA, USA

    D L Schutzman

  2. Department of Pediatrics, Michigan State University, Lansing, MI, USA

    E Gatien

  3. Division of Neonatology, Saint Christopher’s Hospital for Children, Philadelphia, PA, USA

    S Ajayi

  4. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    R J Wong

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  1. D L Schutzman
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  2. E Gatien
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  4. R J Wong
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Correspondence to D L Schutzman.

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Schutzman, D., Gatien, E., Ajayi, S. et al. Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT+ infants. J Perinatol 36, 386–388 (2016). https://doi.org/10.1038/jp.2015.206

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