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The increased destruction of fetal red cells can be immune (allo- or autoantibodies) or nonimmune (hemoglobinopathies, enzyme defects, and membrane defects) in nature and can cause shortened life span of red cells leading to hemolytic disease of the fetus and newborn. Maternofetal ABO incompatibility is common but rarely leads to severe anemia due to poorly developed A or B antigens on fetal red blood cells and neutralization of antibody by tissue and soluble ABO blood group substances in plasma, while RhD hemolytic disease of newborn (HDN) occurring due to D-antigen sensitization in D-negative mothers may lead to severe HDN. Here, we report a case of an inborn neonate who was admitted in neonatal intensive care unit of our hospital at day 1 of life with severe hyperbilirubinemia and needed exchange transfusion.

OBJECTIVE: To develop a simple tool for assessing the severity of disability resulting from Japanese encephalitis and whether, as a result, a child is likely to be dependent. METHODS: A new outcome score based on a 15-item questionnaire was developed after a literature review, examination of current assessment tools, discussion with experts and a pilot study. The score was used to evaluate 100 children in Malaysia (56 Japanese encephalitis patients, 2 patients with encephalitis of unknown etiology and 42 controls) and 95 in India (36 Japanese encephalitis patients, 41 patients with encephalitis of unknown etiology and 18 controls). Inter- and intra-observer variability in the outcome score was determined and the score was compared with full clinical assessment. FINDINGS: There was good inter-observer agreement on using the new score to identify likely dependency (K = 0.942 for Malaysian children; K = 0.786 for Indian children) and good intra-observer agreement (K = 1.000 and 0.902, respectively). In addition, agreement between the new score and clinical assessment was also good (K = 0.906 and 0.762, respectively). The sensitivity and specificity of the new score for identifying children likely to be dependent were 100% and 98.4% in Malaysia and 100% and 93.8% in India. Positive and negative predictive values were 84.2% and 100% in Malaysia and 65.6% and 100% in India. CONCLUSION: The new tool for assessing disability in children after Japanese encephalitis was simple to use and scores correlated well with clinical assessment.