Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center-Istanbul, Turkey.
Niger J Clin Pract. 2022 Aug;25(8):1262-1268. doi: 10.4103/njcp.njcp_1_22.
Alloimmune hemolytic disease of the newborn (AIHDN) results in hemolysis, anemia, hyperbilirubinemia with the potential for brain damage. Intravenous immunoglobulin (IVIG) has been investigated as an alternative low-risk procedure for the treatment of AIHDN in addition to traditional treatment methods such as phototherapy and exchange transfusion (ET).
To evaluate the effectiveness of IVIG therapy in decreasing ET needs based on risk factors and clinical outcomes.
Charts of neonates born >30 weeks of gestation who underwent phototherapy and were administered IVIG therapy due to AIHDN between January 2013 and July 2018 were retrospectively reviewed.
Sixty-three neonates were included in our study. Forty-three of them (68.3) % were full-term infants. ABO incompatibility (n = 33, 52.4%) was the major cause of AIHDN (n = 63). Additional risk factors for jaundice were found to coexist in 95.2% (n = 60) of the infants. Fifteen infants (23.8%) required ET, mostly due to Rh incompatibility (n = 11, 73.3%). Mortality was observed in 3.2% (n = 2) of the patients, 1.6% (n = 1) of whom were related to ET. Serum albumin value was found to be negatively correlated with the requirement for ET (r = 0.713, P < 0.001), whereas serum bilirubin albumin ratio was positively correlated (r = 0.489, _P < 0.001). Nine (14.3%) infants needed a simple transfusion during the hospitalization period, whereas five (7.9%) infants had readmission for simple transfusion after discharge. Apnea was the only complication seen in one (1.6%) patient.
IVIG treatment should be considered due to its relative benefits when compared to exchange transfusion. In addition to its safety, it is a less complicated treatment modality with low side effect rates. It may be justified for elective use in neonates suffering from AIHDN, who will require ET with a risk of mortality by decreasing the peak of total serum bilirubin levels.
新生儿同种免疫性溶血病（AIHDN）可导致溶血、贫血、高胆红素血症，并有潜在的脑损伤风险。静脉注射免疫球蛋白（IVIG）已被研究作为除光疗和换血（ET）等传统治疗方法之外，治疗 AIHDN 的一种低风险替代方法。
根据危险因素和临床结果，评估 IVIG 治疗降低 ET 需求的效果。
回顾性分析了 2013 年 1 月至 2018 年 7 月期间，因 AIHDN 接受光疗并接受 IVIG 治疗的胎龄>30 周新生儿的病历。
本研究共纳入 63 例新生儿。其中 43 例（68.3%）为足月儿。ABO 不相容（n=33，52.4%）是 AIHDN 的主要原因（n=63）。95.2%（n=60）的患儿存在其他黄疸危险因素。15 例（23.8%）患儿需要 ET，主要是由于 Rh 不相容（n=11，73.3%）。3.2%（n=2）的患儿死亡，其中 1.6%（n=1）与 ET 相关。血清白蛋白值与 ET 的需求呈负相关（r=0.713，P<0.001），而血清胆红素白蛋白比值呈正相关（r=0.489，_P<0.001）。9 例（14.3%）患儿在住院期间需要单纯输血，5 例（7.9%）患儿出院后因单纯输血再次入院。1 例（1.6%）患儿出现呼吸暂停。
与换血相比，IVIG 治疗具有相对优势，应考虑使用。除了安全性之外，它还是一种治疗方法，其并发症发生率低，治疗过程相对简单。对于需要 ET 治疗、有死亡率风险的 AIHDN 新生儿，它可能是合理的选择，因为它可以降低总胆红素水平峰值，从而降低疾病严重程度。
