The aim of the study was to investigate the clinical manifestations and laboratory parameters in newborns with different forms of hemolytic disease of the newborn (HDN). In order to reduce disability, the study analyzed cases of ABO blood group incompatibility and Rh incompatibility in newborns.
Materials and Methods
Medical records and the results of clinical and laboratory examinations of 35 newborns diagnosed with hemolytic disease were analyzed. Of these, 19 newborns had Rh incompatibility (Group I), while 16 newborns had ABO incompatibility (Group II).
The analysis of the clinical and laboratory characteristics of newborns admitted to the Neonatology Department of the Regional Children's Multidisciplinary Medical Center in Samarkand showed the following distribution of blood groups among patients with Rh-incompatibility-related hemolytic disease: blood group A (II) was the most common, occurring in 9 children (47.3%), followed by blood group O (I) in 8 children (42.1%). Blood group B (III) was observed less frequently, in 2 children (10.6%), while blood group AB (IV) was not identified.
Among newborns with ABO antigen incompatibility, blood group A (II) was also the most prevalent, occurring in 8 children (50%), followed by blood group O (I) in 6 children (37.5%). Blood group B (III) was observed in 2 cases (12.5%).
When assessing the clinical form and severity of hemolytic disease in the newborns studied, a severe course of the icteric form was observed in 45.8% of children in Group I and 31.6% of children in Group II. A severe course of the anemic form was observed in the same proportions. A moderate course of the disease was diagnosed in 33.3% of newborns in Group I and 31.6% of newborns in Group II. A mild course was observed in 20.9% and 36.8% of newborns in Groups I and II, respectively.
The most important clinical and laboratory indicator characterizing hemolytic disease of the newborn is hyperbilirubinemia. In newborns with Rh-incompatibility-related hemolytic disease, early onset of hyperbilirubinemia, within the first 6 hours of life, was observed in 66.7% of cases, which was more frequent than in newborns with ABO incompatibility (42.1%).
In 47.9% of newborns with ABO hemolytic disease, jaundice was detected at the end of the first day of life.
Analysis of bilirubin levels in the two groups showed that, in newborns with Rh-incompatibility-related hemolytic disease, total serum bilirubin levels were 34.1 ± 5.3 μmol/L in mild disease, 44.6 ± 3.4 μmol/L in moderate disease, and 78.9 ± 7.42 μmol/L in severe disease. The mean hourly increase in bilirubin was 7.3 ± 6 μmol/L.
In newborns with ABO antigen incompatibility, the mean bilirubin level was 38.9 ± 4.2 μmol/L in mild disease, 42.5 ± 9.9 μmol/L in moderate disease, and 68.8 ± 8.3 μmol/L in severe disease. The mean hourly increase in bilirubin was 7.0 ± 0.9 μmol/L.
The study demonstrated that hemolytic disease of the newborn associated with Rh incompatibility tends to have a more severe clinical course compared with hemolytic disease associated with ABO incompatibility, which affects the intensity and urgency of therapeutic interventions.
Therefore, newborns born to Rh-negative mothers should be subject to strict clinical follow-up and regular medical monitoring. Such an approach may contribute to reducing the risk of disability and mortality among affected children.
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