Frontiers in Pediatrics (Apr 2022)

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

  • Emel Okulu,
  • Omer Erdeve,
  • Ilknur Kilic,
  • Ozgur Olukman,
  • Sebnem Calkavur,
  • Gokhan Buyukkale,
  • Merih Cetinkaya,
  • Dilek Ulubas,
  • Nihal Demirel,
  • Nihal Demirel,
  • Deniz Hanta,
  • Sabahattin Ertugrul,
  • Nazli Dilay Gultekin,
  • Oguz Tuncer,
  • Nihat Demir,
  • Leyla Bilgin,
  • Nejat Narli,
  • Duran Yildiz,
  • Demet Terek,
  • Ozge Altun Koroglu,
  • Canan Seren,
  • Elif Ozyazici,
  • Ramazan Ozdemir,
  • Hatice Turgut,
  • Fatma Narter,
  • Yasemin Akin,
  • Ahmet Ozyazici,
  • Aysegul Zenciroglu,
  • Huseyin Selim Asker,
  • Zeynel Gokmen,
  • Musa Salihli,
  • Ali Bulbul,
  • Umut Zubarioglu,
  • Begum Atasay,
  • Esin Koc,
  • Turkish Neonatal Society IVIG Study Group,
  • Kurthan Mert,
  • Akan Yaman,
  • Evrim Alyamac Dizdar,
  • Nurdan Uras,
  • Berna Hekimoglu,
  • Ayse Engin Arisoy,
  • Yasemin Senel,
  • Eren Ozek,
  • Hulya Ozdemir,
  • Kadir Tekgunduz,
  • Ibrahim Caner,
  • Sema Tanriverdi,
  • Dilek Sarici,
  • F. Mehmet Kislali,
  • Didem Aliefendioglu,
  • Nilufer Guzoglu,
  • Cumhur Aydemir,
  • Muhittin Celik,
  • Belma Saygili Karagol,
  • Bilge Bayraktar,
  • Suzan Sahin,
  • Ibrahim Murat Hirfanoglu,
  • Betul Acunas,
  • Ferda Ozlu,
  • Ayse Ecevit,
  • Cengiz Arcagok,
  • Neslihan Tekin,
  • Hacer Ergin,
  • Selda Arslan,
  • Asuman Coban

DOI
https://doi.org/10.3389/fped.2022.864609
Journal volume & issue
Vol. 10

Abstract

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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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