Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real?

Beken, Serdar; Hırfanoğlu, İbrahim Murat; Türkyılmaz, Canan; Altuntaş, Nilgün; Ünal, Sezin; Turan, Özden; Önal, Esra; Ergenekon, Ebru; Koç, Esin; Atalay, Yıldız

doi:10.1007/s12288-012-0186-3

Cited by 17 publications

(16 citation statements)

References 18 publications

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“…The Cochrane SR included one study not included in the SR conducted by Lois and colleagues. The two retrospective studies focused on ABO incompatibility 25,26 . For Rh‐mediated HDN, data and analysis from both SRs were utilized to make recommendations regarding the benefit of IVIG for Rh‐mediated HDN.…”

Section: Resultsmentioning

confidence: 99%

“…The two retrospective studies focused on ABO incompatibility. 25,26 For Rh-mediated HDN, data and analysis from both SRs were utilized to make recommendations regarding the benefit of IVIG for Rh-mediated HDN. For ABO-mediated HDN, data and analysis from one of the SRs 23 were used to make recommendations for use of IVIG for ABO-mediated HDN as separate data were available for ABO incompatibility.…”

Section: Study Inclusionmentioning

confidence: 99%

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International guidelines regarding the role of IVIG in the management of Rh‐ and ABO‐mediated haemolytic disease of the newborn

et al. 2022

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Haemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international panel of experts was convened to develop evidence‐based recommendations regarding the effectiveness and safety of IVIG to reduce the need for ETs, improve neurocognitive outcomes, reduce bilirubin level, reduce the frequency of red blood cell (RBC) transfusions and severity of anaemia, and/or reduce duration of hospitalization for neonates with Rh or ABO‐mediated HDN. We used a systematic approach to search and review the literature and then develop recommendations from published data. These recommendations conclude that IVIG should not be routinely used to treat Rh or ABO antibody‐mediated HDN. In situations where hyperbilirubinaemia is severe (and ET is imminent), or when ET is not readily available, the role of IVIG is unclear. High‐quality studies are urgently needed to assess the optimal use of IVIG in patients with HDN.

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Section: Resultsmentioning

confidence: 99%

Section: Study Inclusionmentioning

confidence: 99%

International guidelines regarding the role of IVIG in the management of Rh‐ and ABO‐mediated haemolytic disease of the newborn

et al. 2022

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“…[12][13][14] On the other hand, in addition to studies suggesting that IVIG inhibits hemolysis by blocking Fc receptors in the reticuloendothelial system, slowing the increase rate of bilirubin and decreasing the requirement for exchange transfusion by lowering high bilirubin levels, some studies have found that it is not effective. [15][16][17][18][19] However, according to the American Academy of Pediatrics, it is recommended to administer 0.5 to 1 g/kg IVIG to neonates with a rising bilirubin level despite intensive phototherapy or bilirubin level close to the exchange transfusion threshold level, and to repeat the dose after 12 hours, if necessary. 20 In neonates with ABO incompatibility, hemolysis and UCH development that cannot be controlled by phototherapy and require exchange transfusion and IVIG are rare.…”

Section: Discussionmentioning

confidence: 99%

Hemolysis due to Alpha-Hemolytic Enterococcus Urinary Infection: A Rare Cause of Early and Severe Unconjugated Hyperbilirubinemia in a Neonate

Karabulut

Gafil

2020

J Pediatr Intensive Care

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The reason for reporting this case is to remind that some microorganisms may cause hemolysis leading to early and severe hyperbilirubinemia by secreting hemolysin in cases; where bilirubin levels cannot be successfully decreased despite effective phototherapy, intravenous immunoglobulin, and even exchange transfusion, or in cases of increased rebound bilirubin (although urinary tract infection is associated with increased conjugated bilirubin fraction and prolonged jaundice). The most common causes of hemolysis are ABO/Rh incompatibility and enzyme deficiencies such as glucose-6-phosphate dehydrogenase (G6PDH), pyruvate kinase (PK), and galactose-1-phosphate uridyltransferase (GALT). Our patient was a male infant, weighing 3,160 g, at 38 + 4 gestational week; he was referred to our unit with total bilirubin level of 14.7 mg/dL recorded at the postnatal 20th hour and was initiated treatment with intensive phototherapy and prepared for exchange transfusion. The G6PD, PK, and GALT enzyme levels studied at the postnatal 96th hour and reducing substances in urine were detected to be normal/negative, whereas complete urinalysis revealed pyuria (7 leukocytes per each high power field). α-hemolysis-producing 105 colony-forming unit/mL Enterobacter cloacae grew on blood agar in the urine culture. As reported in our case, hemolysin-secreting α and β-hemolytic bacteria can lead to severe and early hemolysis and unconjugated hyperbilirubinemia, as in blood type incompatibility and enzyme deficiencies.

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“…More recently, an association with necrotizing enterocolitis has also been described [13]. However, IVIG has been deemed safe, and is generally well tolerated with a limited side effect profile [7-10, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Immunoglobulins as Adjunct Treatment to Phototherapy in Isoimmune Hemolytic Disease of the Newborn: A Retrospective Case-Control Study

et al. 2019

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BackgroundIsoimmune hemolytic disease is a major cause of neonatal severe indirect hyperbilirubinemia that requires phototherapy or exchange transfusion which is an invasive procedure to avoid brain injury. Administration of intravenous immunoglobulin (IVIG) is used as an adjunct treatment to phototherapy in order to decrease the rate of exchange transfusion.MethodsThis retrospective case-control study aimed to describe the safety and efficacy of IVIG therapy in newborns with isoimmune hemolytic disease and to compare their clinical outcomes to those of a control group who were treated only with phototherapy. Criteria for IVIG treatment were variable; when phototherapy threshold was reached or when exchange transfusion level was approached, using either indication is based on the attending discretion.ResultsNinety-four infants were included in the IVIG group, compared to 108 infants in the control group. Most of the included infants were term infants and most common cause was ABO incompatibility. There were no side effects documented in all the included infants. The IVIG group had more severe hemolysis with average highest bilirubin of 14.6 ± 3.7 mg/dL in the IVIG group versus 12.6 ± 3 in the control group (P = 0.0001). Complication of hemolysis was seen more in the IVIG group with higher rate of rebound hyperbilirubinemia, blood transfusion and exchange transfusion.ConclusionsIVIG use as an adjunct treatment to phototherapy in isoimmune hemolytic disease of the newborns is safe. The favorable results of the phototherapy only group were supportive of using selective criteria for administration of IVIG in neonates with isoimmune hemolytic disease.

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Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real?

Cited by 17 publications

References 18 publications

International guidelines regarding the role of IVIG in the management of Rh‐ and ABO‐mediated haemolytic disease of the newborn

International guidelines regarding the role of IVIG in the management of Rh‐ and ABO‐mediated haemolytic disease of the newborn

Hemolysis due to Alpha-Hemolytic Enterococcus Urinary Infection: A Rare Cause of Early and Severe Unconjugated Hyperbilirubinemia in a Neonate

Intravenous Immunoglobulins as Adjunct Treatment to Phototherapy in Isoimmune Hemolytic Disease of the Newborn: A Retrospective Case-Control Study

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