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333 Abo hemolytic disease of the fetus and newborn: thirteen years of data after implementing a universal bilirubin screening and management program

Purpose of study ABO hemolytic disease occurs among neonates with blood groups A or B delivered to group O women. Questions remain about the range of severity of this entity. In 2004 Intermountain Healthcare instituted a neonatal bilirubin screening/management program in which all neonates had a total serum bilirubin (TSB) measurement in their birth hospital plotted on a time-specific (Bhutani) chart, and recommendations for management and follow-up were given to the clinician. We sought to determine the odds of developing severe ABO hemolytic disease in the 13 years since adopting this bilirubin screening/management program. Methods used We conducted a retrospective analysis of neonates born between 2004 and 2016, defining ‘severe’ hemolytic disease as; 1) TSB >25 mg/dL, 2) hospital readmission for treatment of jaundice, or 3) evidence of acute bilirubin encephalopathy. These three outcomes were tabulated in all neonates born to group O(+) mothers. The control group was composed of neonates not at risk for ABO disease because they were group O, and the study group was made up of neonates at risk for ABO disease because they were group A or B. Summary of results Of 4 00 531 live births in the 13 year study period, 47% were to group O women; 86% of whom were group O(+). 42 529 (27%) neonates born to group O(+) women had their blood group determined; 29 729 (68%) were O, 10 682 (25%) A, and 3109 (7%) B. Peak TSBs during the first 10 days were higher in group A (11.0±4.2 mg/dL) and B (11.5±4.3) than group O neonates (10.3±4.1) (A+B vs O p<0.0001). However the relative risks of a TSB ≥25 mg/dL (p=0.062), readmission for jaundice (p=0.665), or acute kernicterus were the same in the control vs study groups. Conclusions In our health system severe hemolytic disease in neonates born to group O(+) woman is not more likely in group A or B neonates than in group O neonates. We recognise that in practices that do not have a bilirubin screening/management program, ABO hemolytic disease severity might be different than in our system.