NEONATAL
JAUNDICE IN BOSNIAN NEWBORNS: RH ISOIMMUNISATION STILL TAKES A ROLE
Heljić S1, Beganović N2, Maksić
H1, Kalkan I1
(1) NICU,
Pediatric Clinic KCU, Sarajevo, Bosnia and Herzegovina
(2) Clinic of Gynecology and Obstetrics, KCU, Sarajevo,
Bosnia and Herzegovina
Objective:
Because of extensive prevention of Rh hemolitic disease and effective
bilirubin lowering therapy, the picture of classical kernicterus in
developed world has almost disappeared.
Methods: We
retrospectively evaluated 416 babies with discharge diagnosis of
non-physiologic hyperbilirubinaemia in 2-years period. Laboratory tests
included: Bilirubin measurement, Blood type, Bood groupe, Direct Coombs’
test, Complete Blood Cell count, and the other tests (infection detection,
etc.) as necessary. Serum bilirubin was measured on an automated chemical
analyser, using a direct bichromatic spectrophotometric assay.
Results: Rh
isoimmune hemolitic disease was found in 39 out of 416 hospitalized
patients with non-physiologic hyperbilirubinaemia. In 31/39 one or more
blood exchanges transfusions were performed. 4/39 babies received high dose
intravenous immune gamma –globulin. 1/39 child, born in a small outside
hospital, at admission had the apparent signs of bilirubin encephalopathy.
Conclusion:
Rh hemolitic disease, because of lack of systemic prevention during the war
is still a significant cause of newborn jaundice in post-war Bosnia and
Herzegovina. Rho (D) immune globulin (Rhogam) should be available and given
to all unsensitized Rh negative mothers at 28 weeks’ gestation, within 72
hours after delivery, and also following abortion.