Kumar Krishnegowda Vijay, Ramaswamy Viraraghavan Vadakkencherry, Abiramalatha Thangaraj, Bandyopadhyay Tapas, S Abdul Kareem Pullattayil, Kannan Loganathan Prakash
Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India.
Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India.
Front Pediatr. 2025 Jan 28;12:1475623. doi: 10.3389/fped.2024.1475623. eCollection 2024.
The direct antiglobulin test (DAT) is commonly used as a screening test for predicting significant neonatal hyperbilirubinemia requiring intervention. However, evidence for this approach is limited.
The aim of this study was 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 conditions.
MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science were searched from inception until 1 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 test accuracy meta-analyses. Risk of bias was assessed using Quality Assessment for Studies of Diagnostic Accuracy 2 and certainty of evidence (CoE) was adjudged according to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines.
In total, 53 studies were included in the systematic review and 28 were synthesized in the meta-analysis. For the need for phototherapy outcome, the pooled sensitivity [95% credible interval (CrI)] and specificity (95% CrI) of DAT in ABO incompatibility (18 studies, = 10,110) were 56.1% (44.5%-67.8%) and 83.6% (71.6%-90.8%). For Rh incompatibility (three studies, = 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 need for DVET outcome, the pooled sensitivity and specificity of DAT in ABO incompatibility (three studies, = 2,652) were 83.6% (35.8%-99.6%) and 74.5% (40.3%-92.7%). For Rh incompatibility (two studies, = 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 high-risk neonates.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022297785, PROSPERO (CRD42022297785).
直接抗球蛋白试验（DAT）通常用作预测需要干预的显著新生儿高胆红素血症的筛查试验。然而，这种方法的证据有限。
本研究的目的是评估DAT在预测ABO和恒河猴（Rh）血型不合情况下新生儿光疗和双倍量换血输血（DVET）需求方面的诊断效用。
检索MEDLINE、Embase、CENTRAL、CINAHL和Web of Science数据库，时间跨度从建库至2024年2月1日。随机对照试验（RCT）和非RCT均符合纳入标准。两名评审员相互 blinded 筛选标题和摘要。采用贝叶斯双变量随机效应模型进行诊断试验准确性的荟萃分析。使用诊断准确性研究质量评估2评估偏倚风险，并根据推荐分级、评估、制定和评价（GRADE）指南判定证据确定性（CoE）。
系统评价共纳入53项研究，荟萃分析纳入28项研究。对于光疗需求结局，ABO血型不合（18项研究，n = 10,110）中DAT的合并敏感性[95%可信区间（CrI）]和特异性（95% CrI）分别为56.1%（44.5% - 67.8%）和83.6%（71.6% - 90.8%）。对于Rh血型不合（3项研究，n = 491），敏感性和特异性分别为40.4%（12.2% - 81.7%）和89.9%（72.7% - 94.6%）。CoE主要为低。对于DVET需求结局，ABO血型不合（3项研究，n = 2,652）中DAT的合并敏感性和特异性分别为83.6%（35.8% - 99.6%）和74.5%（40.3% - 92.7%）。对于Rh血型不合（2项研究，n = 240），敏感性和特异性分别为80.3%（34.2% - 97.3%）和68.0%（25.3% - 92.1%）。CoE主要为极低。
在ABO和Rh血型不合中，DAT预测光疗需求可能具有中等特异性和低敏感性。对于DVET，尽管由于其可接受的敏感性，DAT可能是更好的预测指标，但预测区间较宽。因此，我们不建议常规使用DAT筛查来预测光疗和DVET的需求。然而，它可作为高危新生儿风险分层的二线检查。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022297785，PROSPERO（CRD42022297785）
