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Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT(+) infants.
J Perinatol. 2016 05; 36(5):386-8.JP

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.

Authors+Show Affiliations

Department of Pediatrics and Adolescent Medicine, Einstein Medical Center, Philadelphia, PA, USA.Department of Pediatrics, Michigan State University, Lansing, MI, USA.Division of Neonatology, Saint Christopher's Hospital for Children, Philadelphia, PA, USA.Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26765551

Citation

Schutzman, D L., et al. "Carboxyhemoglobin Levels as a Predictor of Risk for Significant Hyperbilirubinemia in African-American DAT(+) Infants." Journal of Perinatology : Official Journal of the California Perinatal Association, vol. 36, no. 5, 2016, pp. 386-8.
Schutzman DL, Gatien E, Ajayi S, et al. Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT(+) infants. J Perinatol. 2016;36(5):386-8.
Schutzman, D. L., Gatien, E., Ajayi, S., & Wong, R. J. (2016). Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT(+) infants. Journal of Perinatology : Official Journal of the California Perinatal Association, 36(5), 386-8. https://doi.org/10.1038/jp.2015.206
Schutzman DL, et al. Carboxyhemoglobin Levels as a Predictor of Risk for Significant Hyperbilirubinemia in African-American DAT(+) Infants. J Perinatol. 2016;36(5):386-8. PubMed PMID: 26765551.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Carboxyhemoglobin levels as a predictor of risk for significant hyperbilirubinemia in African-American DAT(+) infants. AU - Schutzman,D L, AU - Gatien,E, AU - Ajayi,S, AU - Wong,R J, Y1 - 2016/01/14/ PY - 2015/09/11/received PY - 2015/11/21/revised PY - 2015/11/24/accepted PY - 2016/1/15/entrez PY - 2016/1/15/pubmed PY - 2018/1/19/medline SP - 386 EP - 8 JF - Journal of perinatology : official journal of the California Perinatal Association JO - J Perinatol VL - 36 IS - 5 N2 - 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. SN - 1476-5543 UR - https://wwww.unboundmedicine.com/medline/citation/26765551/Carboxyhemoglobin_levels_as_a_predictor_of_risk_for_significant_hyperbilirubinemia_in_African_American_DAT_+__infants_ L2 - https://doi.org/10.1038/jp.2015.206 DB - PRIME DP - Unbound Medicine ER -