Abstract
Objective Hemolytic disease of the newborn (HDN) most commonly occurs in neonates whose mothers
carry nonpassively acquired antibodies directed against red blood cell (RBC) antigens.
Because affected neonates may develop severe hyperbilirubinemia, early identification
of at-risk neonates is critically important. We hypothesized that use of the direct
antibody test (DAT) would be of high predictive value in identifying those neonates
most likely to meet treatment criteria for hyperbilirubinemia.
Study Design We performed a retrospective chart review of all mother–infant pairs in which RBC
antibodies were detected on routine prenatal screening during the current pregnancy
(2011–2013). We then compared DAT results of neonates who eventually met the treatment
criteria for hyperbilirubinemia with those who did not.
Main Results Fifty-sixty neonates were born to mothers with clinically significant antibodies.
The sensitivity and specificity of a positive DAT result for meeting the treatment
criteria were 87.5 and 93.3%, respectively. The positive and negative predictive values
were 77.8 and 96.6%, respectively.
Conclusion The result of a DAT, obtained in neonates of mothers with clinically relevant alloantibodies,
is a specific marker with good positive predictive value for identifying those who
are most likely to meet the treatment criteria for hyperbilirubinemia.
Keywords
coombs test - fluorescent antibody technique - direct - hemolytic disease of newborn
- hyperbilirubinemia - infant - newborn
