Results

A total 106 patients admitted to hospital and included in present study. These patients divided into O-A and O-B groups.
Group No. O-A 65 O-B 41 % 61.3 39.7

Table (1): Distribution of ABO jaundice according to gender in study group

Group A No 41 24 65 % 63.1 36.9 100 B No 23 18 41 % 56.1 43.9 100 Total No 64 42 106 % 60.4 39.6 100 0.512 0.474 NS X2 test P value

Gender Male Female Total

Table (1) shows the sex distribution of patients. In group A, 41cases (63.1%) were male patients while 24 cases (36.9%) were female patients. In group B, 23 cases (56.1%) were male patients while 18 cases (43.9%) were female patients.

Table (2): Comparison between O-A and O-B patients regarding maternal risk factors in study group
Group A(n=65) No Maternal Risk factors Mode of delivery NVD CS 33 32 50.7 49.3 18 23 44 56 51 55 48.1 51.9 % B(n=41) No % Total No % x2 test P value

Maternal risk factors

A No. % 23 24.6 29.2 12.3 6.2 4.7 95.4 4.6 75.4 24.6 69.2 30.8

B No. 8 11 5 7 10 0 41 0 29 12 28 13 % 19.5 26.8 12.2 17.1 24.4 0 100 0 70.7 29.3 68.3 31.7

Total No. 23 27 24 15 14 3 103 3 78 28 73 33 % 21.7 25.4 22.7 14.2 13.2 2.8 97.2 2.8 73.6 27.4 86.9 31.1

T test

P value

Gravidity

1 2 3 4 5 6

15 16 19 8 4 3 62 3 49 16 45 20

Previous blood transfusion Spontaneous abortion Maternal drug intake nitrofurantoin

No Yes No Yes No Yes

1.947

0.282 NS

0.28

0.597 NS

0.01

0.919 NS

Salicylates

No Yes

61 4 64 1 33 32 62 3

93.8 6.2 98.5 1.5 50.8 49.2 95.4 4.6

40 1 41 0 23 18 41 0

97.6 2.4 100.0 0.0 56.1 43.9 100.0 0.0

101 5 105 1 56 50 103 3

95.3 4.7 99.1 0.9 52.8 47.2 97.2 2.8

0.772

0.647 NS

Sulfonamide

No Yes

0.637

1.0 NS

Oxytocin intake in delivery

No Yes

0.286

0.593 NS

Instrumental delivery

No Yes

1.947

0.282 NS

Table (2) shows maternal risk factors in group A and group B patients. Firstly patients delivered by normal vaginal delivery (NVD) 51 patients (48.1%) while 55 patients (51.9%) delivered by caesarian section (CS). Maternal gravida 1 were 23cases (21.7%), gravida 2 were 27 cases (25.4%), gravida 3 were 24 cases (22.7%), gravida 4 were 15 cases (14.2%), gravida 5 were 13 cases (13.2%) and gravida 6 were 3 cases (2.8%). Mothers with previous blood transfusion were 3 cases (2.8%). Mothers with spontaneous abortions were 28 cases (27.4%). The study showed 5 cases with maternal intake of salicylates (4.7%), 1 case with maternal intake of sulfonamide (0.9%), and 33 cases with maternal intake of nitrofurantoin (31.1%). Mothers with oxytocin intake in delivery were 50 cases (47.2%). Mothers with instrumental delivery were 3 cases (2.8%).

Table (3): Comparison between O-A and O-B groups regarding onset of jaundice in hours noted by mothers in study group Variable Groups A Onset of jaundice B 32.78 9.22 Mean SD Range 36.6 8.36 2.202 0.03 S Student t-test P value

Table (3) shows the age of onset of jaundice in patient noted by mother with ABO incompatibility, the most common age presented with jaundice (36.6) hours in group A patients (61%) while in group B patients (39%) presented with jaundice earlier at (32.7) hours with P value (0.03) which is significant .

Table (4): Comparison between O-A&O-B according to family history in study group Group A(n=65) B(n=41) Total test P value

No Family history Sibling with jaundice Treatment of previous siblings with jaundice (78 cases) No Yes Phototherapy Phototherapy plus Ex. transfusion No Yes 18 47 44 3

No

No

27.7 10 72.3 31 94 6 27 4

24.4 75.6 87 13

28 78 71 7

26.4 73.6 91 9

0.141

0.707 NS

G6PD on maternal side

62 3

95.4 40 4.6 1

97.6 2.4

102 4

96.2 3.8

0.328

1.0 NS

Table (4) shows family history of jaundice in patients with Abo incompatibility. There were 47 cases of group A patients (72.3%) presented with previous family history of jaundice, about 44 cases (94%) treated with phototherapy only while 3 cases only (6%) treated with phototherapy plus exchange transfusion. There were 31 cases of group B patients (75.6%) presented with previous family history of jaundice, about 27 cases 87% treated with phototherapy while 4 cases (13%) treated with phototherapy plus exchange transfusion. There were 28 cases (26.4%) without family history of jaundice. Only 3 cases of group A and 1 case of group B presented with history of G6PD on maternal side.

Table (5): Comparison between O-A & O-B according to neonatal history and Physical examination in study group

Group

A(n=65)

B(n=41)

Total

test

P value

No

No

No

Physical exam. Need for resuscitation Delayed 1st cry

No Yes No Yes 58 7 58 7 42 23 63 2 57 8 57 8 45 17 3 89.2 10.8 89.2 10.8 64.6 35.4 96.9 3.1 87.7 12.3 87.7 12.3 69.2 26.2 4.6 34 7 35 6 22 19 41 0 29 12 28 13 27 12 2 82.9 17.1 85.4 14.6 53.7 46.3 100.0 0.0 70.7 29.3 68.3 31.7 65.9 29.3 4.9 92 14 93 13 64 42 104 2 86 20 85 21 72 29 5 86.8 13.2 87.7 13.3 60.4 39.6 98.1 1.9 81.1 18.9 80.2 19.8 67.9 27.4 4.7 0.135 0.935 NS 5.96 0.015 S 4.73 0.03 S 1.286 0.521 NS 1.262 0.261 NS 0.872 0.351 NS

Pallor

No Yes

Dark urine

No Yes

Moro reflex

Normal Weak

Suckling reflex Normal

Weak

Vomiting

No Once Twice

Generalized ecchymosis

No

65

100. 0 0.0 100. 0 0.0 100. 0 0.0 100. 0 0.0 98.5 1.5 98.5 1.5 100. 0 0.0

40

97.6

105

99.1

1.6

0.387 NS

Yes Cephalhematoma No

0 65

1 40

2.4 97.6

1 105

0.9 99.1 1.6 0.387 NS

Yes Extremities ecchymosis No

0 65

1 39

2.4 95.1

1 104

0.9 98.1 3.232 0.147 NS

Yes Extremities bruises No

0 65

2 38

4.9 92.7

2 103

1.9 97.2 4.895 0.055 NS

Yes Extremities hematoma No Yes Abdominal hematoma No Yes Abdominal bruises No

0 64 1 64 1 65

3 41 0 41 0 40

7.3 100.0 0.0 100.0 0.0 97.6

3 105 1 105 1 105

2.8 99.1 0.9 99.1 0.9 99.1 1.6 0.387 NS 0.637 1.0 NS 0.637 1.0 NS

Yes

2.4

0.9

Table (5) shows 13 patients (12.3%) with delayed 1st cry after delivery. These cases needed resuscitation after birth. In group A patients 8 cases (12.8%) with weak moro and suckling reflexes while in group B patients 12 cases (29.3%) presented with weak moro reflex and 13 cases (31.7%) presented with weak suckling reflex sequentially P value shows significant deference between A and B groups in moro and suckling reflexes. 20 cases (18.9%) presented with weak moro reflex at admission, while 21 cases (19.8%) presented with weak suckling at admission. 42 cases (39.6%) presented with pallor on examination and 2 cases (1.9%) presented with dark urine. 29 cases ( 27.4%) had once vomiting at admission while 5 cases only (4.7%) had twice vomiting at admission. There were 10 cases of sequestrated blood which include generalized ecchymosis, cephalhematoma, extremities hematoma, extremities bruises, extremities ecchymosis, abdominal hematoma and abdominal bruises.
6

Table (6): Comparison between O-A & O-B according to level of serum bilirubin (total & direct) at admission at 6, 12, 24, 36 & 48 hours of admission in study group
Variable Groups A B A Dsb at admission Tsb at 6 h. after admission Dsb at 6 h. after admission Tsb at 12 h. after admission Dsb at 12 h. after admission Tsb at 24 h. after admission Dsb at 24 h. after admission Tsb at 36 h. after admission Dsb at 36 h. after admission Tsb at 48 h. after admission Dsb at 48 h. after admission B A B A B A B A B A B A B A B A B A B A B Mean 18.08 21.03 1.22 1.65 17.16 19.66 1.27 1.35 16.15 18.33 1.46 1.32 14.89 17.26 1.22 1.31 13.45 16.19 1.19 1.29 12.45 14.75 1.08 1.2 SD 3.23 4.13 0.47 1.74 2.39 4.03 0.46 0.45 2.28 3.43 1.77 0.59 2.33 3.77 0.35 0.79 2.7 3.22 0.41 0.66 2.31 3.29 0.39 0.596
*= Mann-Whitney test

Student t test

P value

Tsb at admission

4.073

0.001 HS

*1.84

0.065 NS

3.94

0.001 HS

0.863 3.9

0.39 NS 0.001 HS

*0.152

0.879 NS

3.98

0.001 HS

0.80

0.426 NS

4.718

0.001 HS

0.876

0.383 NS

4.198

0.001 HS

1.287

0.201 NS

Tsb = total serum bilirubin Dsb = direct serum bilirubin 7

Table (6) shows high significant difference statistically between O-A and O-B groups in total serum bilirubin level at admission at 6, 12, 24, 36 & 48 hours of admission, while there is no significant difference between O-A and O-B groups in direct serum bilirubin level at admission at 6, 12, 24, 36 & 48 hours of admission. Table (7): Comparison between O-A & O-B according to mean number of hours for extensive phototherapy (double & triple) in study group Variable Extensive phototherapy D plus T Groups A B Mean no. of hrs. 34.06 45.66 SD 26.57 2.23 25.2 0.028 S Student t test P value

Table (7) shows there is significant difference between O-A and O-B groups in their need for extensive phototherapy.
N.B: unit of phototherapy was suggested by authors in order to make a standard that describe the total amount of phototherapy received by patients for easier comparing.

Table (8): Comparison between O-A & O-B according to mean number of time units of phototherapy (one unit of phototherapy = one hour of four
lamps of valid potency, about 50 cm distance from patient)

Variable Extensive phototherapy D2 plus T3

Groups A B

Mean 75.8 107.12

SD 62.02 64.98

Student t test 2.49

P value

0.015 S

D2 = Double phototherapy for one hour T3 = triple phototherapy for one hour

Table (8) shows significant difference between O-A and O-B groups in time units needed for extensive phototherapy. We calculated the units for every patient with B & A groups to compare number of them for each group.
8

Table (9): Comparison between O-A & O-B according to Duration of admission in study group Variable Duration of admission S+D+T Groups A B Mean no. of hrs. 93.42 98.93 SD 21.06 1.303 21.43 0.195 NS Student t test P value

S+D+T = Single + Double + Triple phototherapy

Table (9) shows no statistical significant difference between O-A and O-B groups in the duration of admission.

Table (10): Comparison between O-A & O-B according to number of exchange transfusion in study group Group A(n=65) B(n=41) Total test P value

TTT (Ex transfusion)

NO of transfusion No Once Twice

N % o

No

No

5 9 6 0

90.8 9.2 0.0

28 11 2

68.3 26.8 4.9

87 17 2

82.1 16.0 1.9

9.57

0.008 HS

Table (10) shows highly significant difference statistically between O-A and O-B groups in need for exchange transfusion.
9

Table (11): Comparison between O-A & O-B according to results of Indirect coombs test in study group Group A(n=65) B(n=41) Total test P value

No Variable Indirect coombs Positive 27

% 41.5 58.5

No 24 17

% 58.5 41.5

No 51 55

% 48.1 51.9 5.18 0.088 NS

Negative 38

Table (11) shows no significant difference between O-A and O-B groups in results of indirect combs test. Table (12): Comparison between O-A & O-B according to CRP in study

group
Group A(n=65) B(n=41) Total test P value

No Variable CRP Positive 7

No

No

10.8 89.2

8 33

19.5 80.5

15 91

14.2 85.8

1.58

0.208 NS

Negative 58

Table (12) shows no significant difference between O-A and O-B groups in results of CRP.
10

Table (13): Comparison between O-A & O-B according to level of serum bilirubin (total & direct) at admission at 6, 12, 24, 36 &48 hours in response to treatment with phototherapy in study group
Groups Admission 6h Tsb for group A 12h 24h 36h 48h Admission 6h 12h Dsb for group A 24h 36h 48h Admission 6h 12h 24h 36h 48h Admission 6h Dsb for group B 12h 24h 36h 48h
Tsb = total serum bilirubin

Mean 18.08 17.16 16.15 14.89 13.45 12.45 1.22 1.27 1.46 1.22 1.19 1.08 21.03 19.66 18.33 17.26 16.19 14.75 1.65 1.35 1.32 1.31 1.29 1.2

SD 3.23 2.39 2.28 2.33 2.7 2.31 0.47 0.46 1.77 0.35 0.41 0.39 4.13 4.03 3.43 3.77 3.22 3.29 1.74 0.45 0.59 0.79 0.66 0.596

Student t test

P value

45.182

0.001 HS

1.649

0.146 NS

Tsb for group B

16.34

0.001 HS

1.278

0.274 NS

Dsb = direct serum bilirubin

Table (13) shows highly significant statistically in response to treatment in both A and B groups.
11

Table (14): comparison between O-A and O-B regarding albumin level in study group Group A(n=65) B(n=41) Total test P value

No Variable Albumin level >3.5 mg/dl <3.5 mg/dl 9 3

No

No

75 25

11 6

64.7 35.3

20 9

69 31

Table (15): Risk factors affecting ABO incompatibility neonatal jaundice Variable Groups Mean S. SD bilirubin at admission 25.98 21.4 26.68 24.9 3.31 0.463 Negative Positive Oxytocin Negative 1.57 0.0 4.03 1.174 0.257 NS 0.65 NS Student t test P value

Positive Family history

12

2 3 Gravidity 4 5 6 NVD Mode of delivery CS Poor feeding positive negative Sequestrated blood Yes No Hypoalbuminemia Yes no

23.0 23.77 23.93 25.65 27.62 26.71 24.6 26.05 23.2 27.6 25.79

0.0 0.78 2.39 1.06 3.59 3.82 1.39 1.42 3.26 0.0 0.0 3.3 0.533 0.601 NS 0.849 0.408 NS 0.185 NS F=1.68 0.214 NS

Table (15) shows that higher mean serum bilirubin in positive cases with previous family history, oxytocin intake in delivery, poor feeding, sequestrated blood and hypoalbuminemia. It shows also higher mean serum bilirubin in NVD than in CS cases. As well as mean serum bilirubin level increases proportionally with gravidity.

13

Table (16): Variable Groups Mean Serum bilirubin level at admission SD Student t-test P value

2 3 Gravidity 4 5 6

A B A B A B A B A B

14

Table (17): Comparison between O-A & O-B according to blood picture in study group Variable A B A B A Platelets B A WBCs B Serum Albumin level A B A Reticulocytes B 9.3 4.16 15.83 3.98 3.72 6.88 4.61 0.185 2.66 0.296 2.56 3.72 0.001 HS 0.013 S 289.1 14.89 65.59 4.48 1.038 0.302 NS Groups Mean 12.59 12.0 34.62 30.35 297.45 SD 1.098 2.35 1.45 5.56 4.092 4.66 73.66 0.592 0.56 NS 0.001 HS 0.021 S Student t test P value

Hemoglobin level

Hematocrit value

Table (17) shows that there are highly statistically significant differences about values of reticulocytes and hematocrit and statistically significant differences about values of hemoglobin and serum albumin between O-A & O-B groups.

15