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764 A Study on the Outcome of Direct Coombs Test (DCT) Positive Neonates
  1. KM Upatissa,
  2. J Greenaway,
  3. S Mahadevan-Bava
  1. Paediatrics, Russells Hall Hospital, Dudley, UK

Abstract

The management and follow up of neonates with DCT+ differ from one centre to another. At RHH, guidelines recommend twice weekly FBC and Bilirubin in the first 2weeks, and review at 4–6weeks.

We retrospectively reviewed 52 DCT+ neonates born at RHH between May 2008 and June 2009 to assess their outcome and to evaluate the need to review the current guideline. We divided the sample into three groups. Group 1: Rh isoimmunisation due to RhD (39/52), 2: other Rh and non Rh alloimmunization (6/52) and 3: with ABO incompatibility (7/52).

In group 1, 38/39 mothers received anti-D prophylaxis(RAADP). 20/39 had weakly positive and 19/39 had moderately DCT+. None of these neonates developed anaemia or prolonged jaundice.

In group 2(n=6), 3/6 were strongly DCT+ and 2/3 developed jaundice < 24hours requiring phototherapy. 3/6 showed moderately DCT+ and 2 required phototherapy in the first week. At 2weeks 4/6 developed anaemia but did not warrant transfusion.

In group 3(n=7), 6 showed moderate DCT+ and 1 weakly DCT+. 5/7 in group 3 received phototherapy in the first week. 5/7 in group 2 developed prolonged jaundice. 1/7 at 2 weeks showed anaemia.

We conclude that

  1. Neonates born to mothers who received RAPPD do not show significant post delivery haemolysis and may not require close monitoring

  2. Those with non RhD alloimmunisation and ABO incompatibility require monitoring for haemolysis at 2 weeks and review at 6 weeks

  3. Although small number in our study, strong positive DCT warrants close monitoring in the first 24 hours of age.

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