Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study

Pan, Jiarong; Zhan, Chenchang; Yuan, Tianming; Chen, Xiangxiang; Ni, Yanyan; Shen, Ying; Chen, Weiwei; Yu, Huimin

doi:10.1038/s41372-021-00963-5

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…The mechanism of IVIG is unclear, but it is thought that IVIG decreases hemolysis by blocking Fc receptors in the reticuloendothelial system and preventing the lysis of antibody-coated erythrocytes ( 12 , 13 ). Although several studies have suggested that IVIG was effective for treating neonatal hemolytic jaundice and decreasing the number of infants that require an exchange transfusion ( 14 – 18 ), some clinical studies found that IVIG treatment failed in the management of infants with ABO HDN ( 19 , 20 ). Recently, a Cochrane review found insufficient evidence to recommend the use of IVIG in alloimmune HDN ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

et al. 2022

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IntroductionIntravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion.Materials and MethodsThis study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2–3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared.ResultsDuring the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups (p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group (p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group (p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group (p < 0.001 and p = 0.01, respectively).ConclusionIn this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility.

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Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

et al. 2022

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“…Anaemia and associated hyperbilirubinaemia in neonates are the most common clinical manifestations of HDN [5,20]. IVIG has been proposed as a potential intervention that can decrease the severity of haemolysis and the associated hyperbilirubinaemia.…”

Section: Discussionmentioning

confidence: 99%

Is intravenous immunoglobulin a risk factor for necrotizing enterocolitis in neonates with haemolytic disease of the newborn? A retrospective cohort study

Zhong

Song

et al. 2022

Vox Sanguinis

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Background and Objectives To assess whether the use of intravenous immunoglobulin (IVIG) in late‐preterm and term newborns with haemolytic disease of the newborn (HDN) is associated with an increased risk of necrotizing enterocolitis (NEC). Materials and Methods A retrospective cohort study was conducted in a tertiary centre. Infants with HDN during early neonatal period (<7 days) who were of ≥34 weeks' gestation and born between January 2019 and October 2021 were included. Propensity score, interaction as well as univariate and multiple logistic regression analyses were employed. Results One‐thousand two‐hundred and fifty‐nine infants with HDN were enrolled, of whom 192 (15.3%) received IVIG. NEC was diagnosed in 29 (2.3%) patients with 5 (2.6%) in the IVIG group and 24 (2.2%) in the non‐IVIG group. No significant association between IVIG administration and confirmed NEC was observed using univariate analysis (p > 0.05). The possible predictors of NEC, as assessed by multivariate analysis, were caesarean delivery, haemoglobin on admission <130 g/L and patent ductus arteriosus (PDA). There was no interactive effect of IVIG against NEC for prematurity, low birth weight, caesarean delivery, haemoglobin on admission <130 g/L and PDA. Conclusions In late‐preterm and term infants with HDN, there was no evidence that the early use of IVIG led to the development of NEC.

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“…ABO hemolitik hastalığı yenidoğan döneminde en sık görülen alloimmün hemolitik hastalıktır. ABO uygunsuzluğu anne-bebek çiftinin yaklaşık %25'inde, ABO hemolitik hastalık ise bebeklerin %1'inden azında görülmektedir (2). YHH'da antikor kaplı eritrositlerin retiküloendoteliyal sistemde yıkılması sonucu bebeklerde ciddi hiperbilirubinemi ve anemi gelişebilmektedir (1,3).…”

Section: Introductionunclassified

ABO Hemolitik Hastalığı Olan Yenidoğan Bebeklerde İntravenöz İmmunglobulin G (IVIG) Kullanımının Klinik Sonuçlar Üzerine Etkisi

Yasa¹,

Uslu²,

Memur³

et al. 2022

jchild

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ABO hemolitik hastalık yenidoğan döneminde en sık görülen alloimmün hemolitik hastalıktır. Hemolitik hastalıklara bağlı gelişen sarılık varlığında geleneksel tedavi yöntemleri fototerapi ve kan değişimi olmakla birlikte hemolizin önlenmesi için intravenöz immunglobulin G (IVIG) tedavisi de kullanılmaktadır. Bu çalışma ile ABO hemolitik hastalığı olan yenidoğan bebeklerde IVIG kullanımının klinik sonuçalar üzerine etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Gebelik yaşı 37 hafta ve üzerinde, direkt coombs testi pozitif olan, indirekt hiperbilirubinemi nedeniyle fototerapi tedavisi başlanan 192 bebek çalışmaya dahil edildi. Enzim eksikliği (G6PD), polisitemi, viseral kanama, sefal hematom, patolojik tartı kaybı, metabolik hastalık ve sepsis şüphesi olan bebekler çalışmaya alınmadı. Bebekler sadece fototerapi alan ve fototerapi tedavisine ek IVIG tedavisi alan bebekler olarak iki grupta retrospektif olarak incelendi. Bulgular: Bebeklerin ortalama gebelik yaşları ve doğum tartıları benzerdi. IVIG uygulanan bebeklerde fototerapi ve hastanede yatış süreleri anlamlı olarak uzun, doğumdaki hemoglobin ve hematokrit değerlerine göre taburculuk değerlerinde gözlenen düşme (∆ Hemoglobin ve ∆ Hematokrit) IVIG uygulanmayan gruba göre anlamlı olarak yüksek bulundu. Hemoliz bulguları devam ettiği için tekrar doz IVIG tedavisi alan bebeklerde ise en yüksek bilirubin düzeyleri ve toplam fototerapi süresi açısından tek doz IVIG tedavisi alan gruba göre anlamlı fark saptanmadı. Tartışma: Bu çalışma ile yenidoğanların ABO hemolitik hastalığında fototerapi tedavisine ek olarak IVIG kullanımının hemolizi önlemediği, fototerapi ve hastanede yatış süresini kısaltmadığı gösterilmiş, tekrarlanan dozlarda IVIG uygulamasının klinik etki olarak tek doz IVIG uygulamasından üstün olmadığı saptanmıştır. ABO hemolitik hastalığa bağlı gelişen indirekt hiperbilirubinemi tedavisinde halen ilk tercih etkin uygulanan fototerapi olmalıdır. ABO hemolitik hastalıkta IVIG kullanımını önermek için geniş hasta sayılı prospektif çalışmalara ihtiyaç vardır.

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Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study

Cited by 11 publications

References 20 publications

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

Is intravenous immunoglobulin a risk factor for necrotizing enterocolitis in neonates with haemolytic disease of the newborn? A retrospective cohort study

ABO Hemolitik Hastalığı Olan Yenidoğan Bebeklerde İntravenöz İmmunglobulin G (IVIG) Kullanımının Klinik Sonuçlar Üzerine Etkisi

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