Does prophylactic phototherapy prevent hyperbilirubinemia in neonates with ABO incompatibility and positive Coombs' test?

Abstract

Objective: The objective of the study was to determine whether initiation of early phototherapy in positive direct Coombs' test (DCT) with ABO-incompatible newborns would prevent severe jaundice.

Study design: A prospective controlled study was performed at Al Qassimi Hospital. Infants born at term and weighing >2000 g with ABO incompatibility and a positive DCT were included in the study. Within their first 4 hours of life and after parental consent, infants were enrolled into one of two groups: prophylactic phototherapy group, which received phototherapy during the first 24 hours of life (group I), or no prophylactic phototherapy, which represents the control group (group II). Selection of infants to either group was by 2-week alternative strategy. Blood group, complete blood count (CBC), reticulocyte count, blood smears, total serum bilirubin (TSB) and DCT were performed on cord blood of all neonates born to mothers with O-positive blood group. CBC, reticulocytes and TSB level were obtained in all enrolled infants at 12, 24, 48, 72, and 96 hours of life.

Results: During the study period, 242 newborns with positive DCT were enrolled. A total of 102 infants were allocated to the prophylactic phototherapy arm and 140 as controls. Prophylactic phototherapy was associated with a significant decrease in the TSB at 24 hours (p=0.002) and at 48 hours (p=0.003) but not later on. The total number of patients who had hyperbilirubinemia at any time during the first 96 hours was significantly less in the prophylactic group (17 vs 45--p=0.006). Prolonged hospital stay because of phototherapy was more frequent in the control group (p=0.03).

Conclusion: Prophylactic phototherapy was associated with a significant reduction of TSB in the first 48 hours of life but not later on. Clinical benefits of this strategy could not be proven.