Neonatal Jaundice: Frequency of Rh-Incompatibility Among Neonates with Jaundice and Role Intensive Phototherapy in Reducing the Need for Exchange Transfusion in HDN
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Abstract
Background: Neonatal jaundice is common during early life, but pathological hyperbilirubinemia associated with Rh incompatibility may progress rapidly and increase the need for intensive treatment. Intensive phototherapy may accelerate bilirubin reduction and reduce exchange transfusion requirement compared with conventional phototherapy. Objective: To determine the frequency of Rh incompatibility among term neonates with pathological jaundice and compare bilirubin decline, phototherapy duration, and exchange transfusion requirement between intensive and conventional phototherapy. Methods: This retrospective comparative cohort study included 350 term neonates with pathological jaundice at a tertiary care hospital in Lahore, Pakistan. The intensive phototherapy group included 175 neonates admitted from January 2024 to March 2026, while 175 historical controls admitted in 2015 received conventional phototherapy. Demographic, maternal, laboratory, and treatment outcomes were analyzed using chi-square, t-test, Mann–Whitney U test, and repeated-measures analysis where applicable. Results: Rh incompatibility was identified in 17/175 neonates (9.7%) in the intensive phototherapy cohort. Rh-incompatible neonates had higher median total serum bilirubin than Rh-compatible neonates, 23.21 versus 18.87 mg/dL (p<0.001). Exchange transfusion was required in 5/175 neonates receiving intensive phototherapy and 39/175 receiving conventional phototherapy, corresponding to 2.9% versus 22.3% (p<0.001). Intensive phototherapy also produced greater reported bilirubin decrement and shorter treatment duration. Conclusion: Rh incompatibility remained an important marker of bilirubin severity, while intensive phototherapy was associated with improved bilirubin control and reduced exchange transfusion requirement.
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