Abstract
Introduction: Blood group incompatibility induced haemolytic jaundice can cause significant morbidity and mortality in the neonates. This present study is to show the usefulness of IVIG in the management of neonatal jaundice.
Objective: To assess the efficacy of early intravenous immunoglobulin in reducing the duration of phototherapy and the need for exchange transfusion in Rh and ABO incompatibility.
Methodology: In this randomised control trial 50 patients diagnosed with haemolytic disease of new-born were grouped into group A and B. All neonates were treated with standard protocol for phototherapy and exchange transfusion. Only group A patients received intravenous immunoglobulin in a dose of 0.5gm/kg of body weight and phototherapy. Exchange transfusion was done to the patients of both groups if the bilirubin reached exchange level in AAP chart.
Result: Improvement in bilirubin level was significant in group A 80 % vs group B 48 % (p-value <0.O5, S). Similarly phototherapy duration was reduced in the group A 76% vs group B 20 % (p<0.05, S). Exchange transfusion was reduced in group A 12% vs group B 48%.
Conclusion: Addition of intravenous immunoglobulin for treatment of haemolytic disease of new born significantly reduces bilirubin levels, duration of phototherapy and need for exchange transfusion.
Keywords: Bilirubin, Immunoglobulin.
References
- Beken S, Hirfanoglu I, Turkyilmaz C, Altuntas N, Unal S, Turan O, et al. Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real? Indian Journal of Hematology and Blood Transfusion. 2012;30(1):12–5.
- Usha KK, Sulochana PV (1998) Detection of high risk pregnancies with relation to ABO hemolytic disease of the newborn. Indian J Pediatr 65:863–865
- Maisels MJ, Kring E (1992) Risk of sepsis in newborns with severe hyperbilirubinemia. Pediatrics 90:741–743
- American Academy of Pediatrics Subcommittee on Hyperbilirubinemia (2004) Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114:297–316
- Urbaniak SJ (1979) ADCC (K cell) lysis of human erythrocytes sensitized with Rhesus alloantibodies. II. Investigation into mechanism of lysis. Br J Haematol 42:315–328.
- Stole BJ, Kleigman RM., Kleigman RM. Hemolytic Disease of the Newborn. In: Behrman: Nelson Text book of pediatrics. Philedelphia: Saunders;2004:601-05. 7. Waheed I, Chisti AL, Alvi A, Iqbal A. Hemolytic disease of newborn. Pak Paed J 2005;29:129-32
- Tan KL, Lim GC, Boey KW. Phototherapy for ABO haemolytic hyperbilirubinemia. Biol Neonate 1992;61:358-65.
- Mukhopadhyay K, Murki S, Narang A. Intravenous immunoglobulins in rhesus hemolytic disease. Indian J Pediatr 2003;70:697-99.
- Gottstein R and Cooke RW. Systemic review of intravenous immunoglobin in hemolytic disease of newborn. Arch Dis Child 2003;88:6-10.
- Miqdad AM, Abdelbasit OB, Shaheed MM. Intravenous immunoglobulin G therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med 2004; 16:163- 66. 13
- Alpay F, Sarıcı SU, Okutan V, Erdem G, Ozcan O, Gökcay E. High-dose intravenous immunglobulin therapy in neonatal immune haemolytic jaundice. Acta Paediatr. 1999;88:216–219. doi: 10.1111/j.1651-2227.1999.tb01085.x. [PubMed] [CrossRef] [Google Scholar]
- Girish G, Chawla D, Agarwal R, Paul VK, Deorari AK. Efficacy of two dose regimes of intravenous immunoglobulin in Rh hemolytic disease of newborn-a randomised controlled trial. Indian Pediatr. 2008;45:653–659. [PubMed] [Google Scholar].
- Mukhopadhyay, K., Murki, S., Narang, A. et al. Intravenous immunoglobulins in rhesus hemolytic disease. Indian J Pediatr 70, 697 (2003). https://doi.org/10.1007/BF02724308
- Smits-Wintjens VE, Walther FJ, Rath ME, Lindenburg IT, te Pas AB, Kramer CM, et al. Intravenous immunoglobulin in neonates with rhesus hemolytic disease: a randomised controlled trial. 2011;127:680–686. doi: 10.1542/peds.2010-3242. [PubMed] [CrossRef] [Google Scholar].
Corresponding Author
Dr Ponung Lego
PGT, Department of Paediatrics, Silchar Medical College and Hospital, Silchar
DOI: https://dx.doi.org/10.18535/jmscr/v9i4.04
