title: Maternal IgG anti-A and anti-B titres predict outcome in ABO-incompatibility in the neonate.
abstract: OBJECTIVE
  To evaluate predictors for risk of severe hyperbilirubinaemia and kernicterus in ABO-incompatible neonates with emphasize on maternal IgG anti-A/-B titres.
  
  
  METHODS
  Blood group O women in labour at Oslo University Hospital, Ullevål, were included in the years 2004-2006. Offspring with blood group A or B had direct antiglobulin test performed and IgG anti-A/-B levels measured in maternal plasma. Blood group A or B infants developing severe hyperbilirubinaemia, received in addition to phototherapy, immunoglobulin treatment and/or exchange transfusion (EXT).
  
  
  RESULTS
  Of 253 neonates, 61.3% had blood group O, 29.6% blood group A and 9.1% blood group B. Twenty neonates with blood group A or B received at least one immunoglobulin treatment. In multivariate analysis, maternal antibody-titres were the only significant predictors for immunoglobulin treatment (p < 0.0001), EXTs (p < 0.05) and duration of phototherapy (p < 0.0001). The need for invasive treatment increased sharply for antibody titres > or =512. Receiver operating characteristic analyses demonstrated that titres > or =512 had a sensitivity of 90% and a specificity of 72% for predicting immunoglobulin treatment and thus severe hyperbilirubinaemia.
  
  
  CONCLUSIONS
  Maternal IgG anti-A/-B titres contribute to the prediction of risk of severe hyperbilirubinaemia in ABO-incompatible neonates, in addition to blood-grouping and direct antiglobulin-testing, especially following early discharge after delivery.
authors.affiliation: Department of Paediatrics, Oslo University Hospital, Ullevål, Oslo, Norway. egil.bakkeheim@uus.no
authors.forename: Egil
authors.initials: E
authors.lastname: Bakkeheim
authors.forename: Unni
authors.initials: U
authors.lastname: Bergerud
authors.forename: Anne-Christine
authors.initials: AC
authors.lastname: Schmidt-Melbye
authors.forename: Ciğdem Akalin
authors.initials: CA
authors.lastname: Akkök
authors.forename: Knut
authors.initials: K
authors.lastname: Liestøl
authors.forename: Drude
authors.initials: D
authors.lastname: Fugelseth
authors.forename: Rolf
authors.initials: R
authors.lastname: Lindemann
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D001787:Blood Group Incompatibility; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000276:immunology* / Q000628:therapy; D007074:Immunoglobulin G / Q000097:blood*; D007231:Infant, Newborn; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D000017:ABO Blood-Group System; D000888:Antibodies, Anti-Idiotypic; D007074:Immunoglobulin G