Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr Roseline Ochieng

Second Supervisor/Advisor

Dr Anthony Ngugi

Third Supervisor/Advisor

Dr Sean Del-Rossi Quadros


Paediatrics and Child Health (East Africa)


Background: ABO incompatibility is one of the most common causes of immune-mediated neonatal jaundice. It occurs in approximately 20-25% of all pregnancies. Literature shows that 60- 80% of newborns will develop physiological jaundice within the first week of life. Globally, the incidence ranges from 10-41%. Early detection of newborns with ABO incompatibility-related jaundice can prevent the incidence of bilirubin-induced neurological dysfunction. Whereas there have been extensive published data on rhesus isoimmunization, very few studies have examined ABO incompatibility and isoimmunization. From the published literature, there has been no known study that has assessed risk factors for developing clinically significant jaundice amongst ABO-incompatible neonates in the Kenyan context.

Objectives: To determine the factors associated with clinically significant hyperbilirubinemia among ABO-incompatible newborns at a tertiary care hospital in Kenya.

Methods: An unmatched case-control study was conducted amongst neonates with blood group A or B who were born to mothers with blood group O positive between March 2016 and December 2022. Consecutive sampling was done until the desired sample size of 83 cases and 83 controls was achieved. Factors such as gestational age, baby’s blood group, mode of feeding, gender, direct Coombs test, mother’s gravidity, and the mode of delivery were obtained from the medical records. Data was collected using a data collection form and entered into Microsoft Excel.

Results: One hundred and sixty-six participants were recruited, comprising 83 cases and 83 controls. Only three of the factors studied were associated with clinically significant jaundice among ABO-incompatible newborns. Mixed feeding with an adjusted OR of 40.22 (CI 5.67-283.95), P=

Conclusions: Isoimmunization caused by ABO hemolytic disease in the newborn has been overlooked as a disease. In the ABO setup, newborns with a positive direct Coombs test, a high reticulocyte count, and mixed or formula feeding are more likely to develop severe jaundice. Therefore, caution should be used when providing for newborns with the abovementioned risks. ABO incompatibility-related jaundice in high-risk infants should be risk-stratified, and prompt interventions should be taken.

Included in

Pediatrics Commons