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SYSTEMATIC REVIEW article

Front. Pediatr.
Sec. Neonatology
Volume 12 - 2024 | doi: 10.3389/fped.2024.1475623
This article is part of the Research Topic Novel targets in pediatrics: advances in diagnostic and therapeutic approaches View all articles

Direct Antiglobulin Test for Prediction of Neonatal Hyperbilirubinemia Needing Intervention: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

Provisionally accepted
Vijay Kumar Krishnegowda Vijay Kumar Krishnegowda 1Viraraghavan Vadakkencherry Ramaswamy Viraraghavan Vadakkencherry Ramaswamy 2Thangaraj Abiramalatha Thangaraj Abiramalatha 3Tapas Bandyopadhyay Tapas Bandyopadhyay 4Abdul Kareem Pullattayil Sulaiman Abdul Kareem Pullattayil Sulaiman 5Prakash Kannan Loganathan Prakash Kannan Loganathan 6*
  • 1 Siksha O Anusandhan University, Bhubaneswar, Odisha, India
  • 2 Ankura Hospital For Women and Children, Hyderabad, Andhra Pradesh, India
  • 3 Kovai Medical Center and Hospitals (KMCH), Coimbatore, Tamil Nadu, India
  • 4 Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
  • 5 Queen's University, Kingston, Ontario, Canada
  • 6 James Cook University Hospital, Middlesbrough, United Kingdom

The final, formatted version of the article will be published soon.

    The Direct Antiglobulin Test (DAT) is commonly used as a screening test for predicting significant neonatal hyperbilirubinemia (NNH) requiring intervention. However, evidence for this approach is limited.Objective: To evaluate the diagnostic utility of DAT in predicting the need for phototherapy and double volume exchange transfusion (DVET) in neonates with ABO and Rhesus (Rh) incompatibility settings.Methods: MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science were searched from inception until 1 st February 2024. Randomized controlled trials (RCTs) and non-RCTs were eligible for inclusion. Two reviewers screened the titles and abstracts blinded to each other. A bayesian bivariate random-effects model was employed for the diagnostic study accuracy (DTA) meta-analyses. Risk of bias was assessed using QUADAS-2 and certainty of evidence (CoE) was adjudged according to the GRADE guidelines.Results: 53 studies were included in the systematic review, and 28 were synthesized in metaanalysis. For the outcome need for phototherapy, the pooled sensitivity (95% credible interval (CrI)) and specificity (95% CrI) of DAT in ABO incompatibility (18 studies, n=10,110) were 56.1% (44.5%, 67.8%) and 83.6% (71.6%, 90.8%). For Rh incompatibility (3 studies, n=491), the sensitivity and specificity were 40.4% (12.2%, 81.7%) and 89.9% (72.7%, 94.6%). The CoE was predominantly low. For the outcome need for DVET, the pooled sensitivity and specificity of DAT in ABO incompatibility (3 studies, n=2,652) were 83.6% (35.8%, 99.6%) and 74.5% (40.3%, 92.7%). For Rh incompatibility (2 studies, n=240), the sensitivity and specificity were 80.3% (34.2%, 97.3%) and 68.0% (25.3%, 92.1%). The CoE was predominantly very low.In ABO and Rh incompatibility, DAT probably has moderate specificity and low sensitivity for predicting the need for phototherapy. For DVET, though DAT is possibly a better predictor due to its acceptable sensitivity, the predictive interval was wide. Thus, we do not suggest the routine use of DAT screening to predict the need for phototherapy and DVET.However, it may be used as a second-tier investigation for risk stratification of such high-risk neonates.

    Keywords: Prospero, CRD42022297785 Neonatal jaundice, Coombs Test, Metanalysis, Newborn, Exchange transfusion

    Received: 04 Aug 2024; Accepted: 27 Dec 2024.

    Copyright: © 2024 Kumar Krishnegowda, Ramaswamy, Abiramalatha, Bandyopadhyay, Pullattayil Sulaiman and Kannan Loganathan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Prakash Kannan Loganathan, James Cook University Hospital, Middlesbrough, TS4 3BW, United Kingdom

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