There were no admissions with neonatal hyperbilirubinemia in less than 24 hours of life. Maximum patients (42, 54.56%) had their peak serum bilirubin levels on day 4 in all 3 groups. None of the studied neonates had G6PD deficiency and blood group incompatibility was observed in 37.7% neonates.with ABO, Rh and ABO +Rh accounting to 31.2%, 5.2%, and 1.3% respectively
In group 3, 17 (60.71%) patients received only phototherapy while exchange transfusion was performed in 11 (39.29%) patients. In group 2, all 30 (100%) patients received only phototherapy. In group 1, 18 (94.74%) patients received phototherapy and one patient did not require any treatment.
BERA was done in 70 patients (3 patients did not consent for BERA) at an average age of 69±6 days. 40 had abnormal BERA and 30 had normal BERA. The most common abnormalities seen were increased latencies of wave V and III. BERA findings in different groups are shown in Fig 2. Correlation of BERA with serum bilirubin was analyzed using student t-test. The mean bilirubin of 22.58 ± 6.08 mg/dL was significantly associated with abnormal BERA (p <0.001). ROC curve for abnormal BERA and serum bilirubin level showed the area under the curve as 93.5% (95% Confidence Interval - 88.2-98.5 %) and the cut off was 16.3mg/dL. Age at peak serum bilirubin did not correlate significantly with the BERA abnormalities (p =0.62).
The p-value for correlation of ABO incompatibility with abnormal BERA was significant (<0.05) when compared with no and Rh incompatibility. Significantly higher (p=0.0061) abnormal BERA was seen in cases with exchange transfusion when compared to phototherapy (odds ratio - 8.43, 95% CI - 1.02 – 31.64 and relative risk - 1.93).
In 77 patients, 70 (90.91%) patients had a normal neurodevelopmental screening at 6 months of age. 3 (3.90%) patients were suspected to have a neurodevelopmental delay. 4 (5.19%) patients lost to follow-up; hence, the assessment could not be done. Distribution as per neurodevelopmental outcome in different groups is shown in fig 3.
At mean indirect bilirubin level of 31.33 ± 7.02 mg/dL, association of suspected neurodevelopmental delay was significantly high (p <0.001). ROC curve for abnormal neurodevelopmental outcome and serum bilirubin level showed AUC as 95.2%, 95% CI - 88.5-100% and the cut off was 23.8 mg/dL. There was no significant correlation between blood group incompatibility and neurodevelopmental delay in any of the groups except in patient with both ABO with Rh incompatibility.(p <0.001)
Significantly higher (p <0.001) suspect cases were seen with exchange transfusion when compared to phototherapy (odds ratio - 31.2, 95% CI - 2.6-55.3). On correlating neurodevelopmental outcome and BERA (table 2), the odds ratio of suspect neurodevelopmental delay with abnormal BERA was 3.21 (95% CI - 0.31-21.4)