Immunoglobulin for alloimmune hemolytic disease in neonates

Zwiers, Carolien; Scheffer-Rath, Mirjam E.A.; Lopriore, Enrico; Haas, Masja de; Liley, Helen

doi:10.1002/14651858.cd003313.pub2

Cited by 41 publications

(52 citation statements)

References 52 publications

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“…7 More recently, based on all included studies a Cochrane review by Zwiers C et al, in 2018 could make no conclusions on the benefit of IVIG in preventing ET or top-up transfusion and therefore routine use in alloimmune HDN is not recommended. 8 In this study Exchange transfusion rates have shown a decreasing trend with an increase in IVIG usage during these 3.5 years as shown in Fig 1. The reason for apparent reduction in ET rates may not necessarily be IVIG alone but earlier recognition and better management, including effective intensive phototherapy and supportive care. When authors tried to check for a possible comparative group, we found that during this study period there were 91 neonates with hemolytic disease with Serum Bilirubin (SBR) in nearexchange range as shown in Table 2.…”

Section: Discussionmentioning

confidence: 50%

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Ghalige

Vaideeswaran

Mangalabharathi

2019

Int J Contemp Pediatr

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Background: Intravenous Immunoglobulin (IVIG) is a blood product manufactured from pooled plasma. With increasing availability, an increased usage in neonates is being noted, though its utilisation has not been audited thoroughly. The objectives of this study are to describe the usage pattern and indications of IVIG and its outcome in a state-run tertiary care NICU.Methods: This retrospective observational study was carried out at the inborn unit of Department of Neonatology, Madras Medical College, Chennai on a cohort of neonates who received IVIG over 3.5 years from January 2016 to June 2019. Data was collected from drug register, neonatal case records, exchange transfusion register and death register.Results: Our study cohort had 55 neonates who received IVIG over 3.5 years. Indications for IVIG usage were Rh-alloimmunisation (23), ABO-alloimmunisation (7), prophylaxis of perinatal varicella (20), and other immune thrombocytopenia (5). Among 30 neonates with ABO-/Rh-incompatibility, 11 required exchange transfusion (ET). ET rates have shown a decreasing trend during this period. 2 babies with Rh-immunisation and Hydrops expired. None of the babies given prophylaxis for perinatal varicella manifested the disease. Neonates treated for immune thrombocytopenia were successfully discharged.Conclusions: This study shows the IVIG usage pattern in a tertiary care neonatal unit. In neonates with Hemolytic disease due to Rh-/ABO-alloimmunisation treated with IVIG, a reduction in rates of exchange transfusion has been noted. IVIG is being used increasingly for prophylaxis of perinatal varicella and immune related thrombocytopenia with promising benefits. It is prudent to have SOPs for IVIG administration with standardised issue and transfusion forms for documentation to regulate its judicious use.

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Section: Discussionmentioning

confidence: 50%

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Ghalige

Vaideeswaran

Mangalabharathi

2019

Int J Contemp Pediatr

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“…Intravenous immunoglobulin (IVIG) remains a recommended treatment modality for neonatal isoimmune hemolytic disease if total serum bilirubin continues to rise despite intensive phototherapy [ 8 ]. However, although some reports suggested a reduction in the need for exchange transfusion after IVIG administration, the practice remains controversial because most clinical trials were not blinded and a recent systematic meta-analysis suggested overall poor quality of evidence and an unknown benefit effect estimate [ 41 ]. In nonneonatal populations, IVIG has been rarely associated with worsening of hemolysis [ 42 ]; if this phenomenon is present in the neonatal population, there is the possibility of actually worsening jaundice from IVIG therapy.…”

Section: Discussionmentioning

confidence: 99%

Predictive Models for Neonatal Follow-Up Serum Bilirubin: Model Development and Validation

Chou¹

2020

JMIR Med Inform

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Background Hyperbilirubinemia affects many newborn infants and, if not treated appropriately, can lead to irreversible brain injury. Objective This study aims to develop predictive models of follow-up total serum bilirubin measurement and to compare their accuracy with that of clinician predictions. Methods Subjects were patients born between June 2015 and June 2019 at 4 hospitals in Massachusetts. The prediction target was a follow-up total serum bilirubin measurement obtained <72 hours after a previous measurement. Birth before versus after February 2019 was used to generate a training set (27,428 target measurements) and a held-out test set (3320 measurements), respectively. Multiple supervised learning models were trained. To further assess model performance, predictions on the held-out test set were also compared with corresponding predictions from clinicians. Results The best predictive accuracy on the held-out test set was obtained with the multilayer perceptron (ie, neural network, mean absolute error [MAE] 1.05 mg/dL) and Xgboost (MAE 1.04 mg/dL) models. A limited number of predictors were sufficient for constructing models with the best performance and avoiding overfitting: current bilirubin measurement, last rate of rise, proportion of time under phototherapy, time to next measurement, gestational age at birth, current age, and fractional weight change from birth. Clinicians made a total of 210 prospective predictions. The neural network model accuracy on this subset of predictions had an MAE of 1.06 mg/dL compared with clinician predictions with an MAE of 1.38 mg/dL (P<.0001). In babies born at 35 weeks of gestation or later, this approach was also applied to predict the binary outcome of subsequently exceeding consensus guidelines for phototherapy initiation and achieved an area under the receiver operator characteristic curve of 0.94 (95% CI 0.91 to 0.97). Conclusions This study developed predictive models for neonatal follow-up total serum bilirubin measurements that outperform clinicians. This may be the first report of models that predict specific bilirubin values, are not limited to near-term patients without risk factors, and take into account the effect of phototherapy.

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“…Supported by these recommendations by the AAP, there was a significant increase in IVIG use in severe hyperbilirubinemia due to AIHD. A recent Cochrane review by Zwiers et al was done in 2018, to further evaluate this practice’s evidence-based aspects [ 55 ]. In their meta-analysis, 27 full-text articles were screened for eligibility.…”

Section: Clinical Use In Fetuses and Neonatesmentioning

confidence: 99%

Intravenous Immune Globulin Uses in the Fetus and Neonate: A Review

Alsaleem

2020

Antibodies

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Intravenous immune globulin (IVIG) is made after processing plasma from healthy donors. It is composed mainly of pooled immunoglobulin and has clinical evidence-based applications in adult and pediatric populations. Recently, several clinical applications have been proposed for managing conditions in the neonatal population, such as hemolytic disease of the newborn, treatment, and prophylaxis for sepsis in high-risk neonates, enterovirus parvovirus and COVID-19 related neonatal infections, fetal and neonatal immune-induced thrombocytopenia, neonatal hemochromatosis, neonatal Kawasaki disease, and some types of immunodeficiency. The dosing, mechanism of action, effectiveness, side effects, and adverse reactions of IVIG have been relatively well studied in adults but are not well described in the neonatal population. This review aims to provide the most recent evidence and consensus guidelines about the use of IVIG in the fetus and neonate.

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Immunoglobulin for alloimmune hemolytic disease in neonates

Abstract: Analysis 3.1. Comparison 3 Intravenous immunoglobulin (IVIg) plus phototherapy versus phototherapy. IVIg administration ≤ 12 hours after birth, Outcome 1 Use of exchange transfusion (≥ 1

Cited by 41 publications

References 52 publications

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Predictive Models for Neonatal Follow-Up Serum Bilirubin: Model Development and Validation

Intravenous Immune Globulin Uses in the Fetus and Neonate: A Review

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