Direkt coombs pozitif yenidoğanlarda light emitting diode fototerapinin etkinliği

Year 2019, , 169 - 173, 29.08.2019

Nilüfer Okur , Mehmet Büyüktiryaki , Nurdan Uras , Mehmet Yekta Öncel , Ömer Ertekin , Fuat Emre Canpolat , Şerife Suna Oğuz

https://doi.org/10.35440/hutfd.525717

Abstract

Amaç: Fototerapi, serum
bilirubin düzeyleri fizyolojik sınırları aştığında en sık kullanılan tedavi
yöntemidir. Direkt antiglobulin titresi (DAT) testi yenidoğanın immün hemolitik
hastalığı tanısının temel taşı olarak kabul edilir.

Materyal ve Metot: Hastanemizde doğan ve
gebelik yaşı 35 haftadan fazla olan hiperbilirubinemili hastalar çalışmaya
alındı. DAT pozitif ve DAT negatif hastalar light emitting diode (LED)
fototerapi etkinliği açısından karşılaştırıldı.

Bulgular: Yetmiş yedi olgu DAT
negatif, 72 olgu DAT pozitif idi. DAT pozitif ve negatif gruplar arasında
fototerapi ve hastanede yatış süresi açısından istatistiksel olarak anlamlı bir
fark bulunmadı. DAT pozitif grupta hastaların fototerapi gereksinimlerinin daha
erken bir aşamada (doğum sonrası yaş 1.4 gün, p <0.05) olduğu tespit edildi,
exchange transfüzyon ve intravenöz immunoglobulin (IVIG) gerektiren hastaların
oranı DAT pozitif bebeklerde istatistiksel olarak anlamlı derecede yüksekti.

Sonuç: LED fototerapi DAT
pozitif hastalarda etkilidir ancak kan değişimi ihtiyacı ve IVIG bu hastalarda
hala daha etkili fototerapiye ihtiyaç olduğunu göstermektedir.

Keywords

Direkt antiglobulin, Hiperbilirubinemi, Yenidoğan, Fototerapi

Effectiveness of light emitting diode phototherapy for direct coombs positive newborns

Abstract

Background: Phototherapy
is the most frequently used treatment when serum bilirubin levels exceed
physiological limits. The direct antiglobulin titer (DAT) test is regarded as
the cornerstone of diagnosis of immune hemolytic disease of the newborn.

Methods: Patients with
hyperbilirubinemia who were born in our hospital and whose gestational age was
over 35 weeks were enrolled. DAT positive and DAT negative patients were
compared in terms of light emitting diode (LED) phototherapy efficacy.

Results: Seventy-seven
cases were DAT-negative and 72 were DAT-positive. No statistically significant
differences were found for the duration of phototherapy and hospitalization
between the DAT-positive and negative groups. In the DAT-positive group, the
phototherapy needs of the patients were determined to occur at an earlier stage
(postnatal age 1.4 day, p<0.05), and the rate of patients requiring exchange
transfusion, blood transfusion and intravenous immunoglobulin was found to be
statistically significant higher in DAT-positive infants.

Conclusions: Although LED
phototherapy is effective in DAT-positive patients, the need for  exchange transfusion and intravenöz
immunoglobulin  (IVIG) shows that there
is still a need for more effective phototherapy in these patients.

Keywords

Direct antiglobulin, hyperbilirubinemia, newborn, phototherapy

References

• 1. Murray NA, Roberts IA. Haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed 2007;92:F83–88
• 2. Madan A, Huntsinger K, Burgos A, Benitz WE. Readmission for newborn jaundice: the value of the Coomb’s test in predicting the need for phototherapy. Clin. Pediatr 2004;43: 63–8
• 3. Ozolek JA, Watchko JF, Mimouni F. Prevalence and lack of clinical significance of blood group incompatibility in mothers with blood type A or B. J Pediatr 1994;125:87–91
• 4. Meberg A, Johansen KB. Screening for neonatal hyperbilirubinaemia and ABO alloimmunization at the time of testing for phenylketonuria and congenital hypothyreosis. Acta Paediatr 1998;87:1269–1274
• 5. Maisels MJ, Kring E. Risk of sepsis in newborns with severe hyperbilirubinemia. Pediatrics 1992;90:741–743
• 6. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114:297– 316
• 7. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or =35 weeks’ gestation: an update with clarifications. Pediatrics 2009; 124:1193– 1198
• 8. Kaplan M, Hammerman C, Vreman HJ, Wong RJ, Stevenson DK. Direct antiglobulin titer strength and hyperbilirubinemia. Pediatrics 2014;134. e1340e4
• 9. Kumar P, Murki S, Malik GK, Chawla D, Deorari AK, Karthi N,et al. Light emitting diodes versus compact fluorescent tubes for phototherapy in neonatal jaundice: a multi center randomized controlled trial. Indian Pediatr 2010;47:131–137
• 10. Meberg A, Johansen KB. Screening for neonatal hyperbilirubinaemia and ABO alloimmunization at the time of testing for phenylketonuria and congenital hypothyreosis.Acta Paediatr 1998; 87:1269–1274
• 11. Herschel M, Karrison T, Wen M, Caldarelli L, Baron B. Evaluation of the direct antiglobulin (Coombs’) test for identifying newborns at risk for hemolysis as determined by end-tidal carbon monoxide concentration (ETCOc); and comparison of the Coombs’ test with ETCOc for detecting significant jaundice. J Perinatol 2002; 22(5):341–347
• 12. Strobel E, Wullenweber J, Peters J. Detection and side effects of isoantibodies in intravenously administered immunoglobulin preparations. Infusionsther Transfusions med 1992;22: 31-35 13. Packman CH. Hemolytic anemia due to warm autoantibodies. Blood 2008; Rev.22: 17-31
• 14. Ozdemir OM, Ergin H, Ince T. A newborn with positive antiglobulin test whose mother took methyldopa in pregnancy. Turk J Pediatr 2008;50: 592-94
• 15. Dillon A, Chaudhari T, Crispin P, Shadbolt B, Kent A. Has anti-D prophylaxis increased the rate of positive direct antiglobulin test results and can the direct antiglobulin test predict need for phototherapy in Rh/ABO incompatibility? J Paediatr Child Health 2011;47:40–3
• 16. Dinesh D. Review of positive direct antiglobulin tests found on cord blood sampling. J Paediatr Child Health 2005;41:504–7
• 17. O. Oztekin, S. Kalay, G. Tezel, E. Barsal E, Bozkurt S, Akcakus M,et al. Is the strength of direct antiglobulin test important for the duration of phototherapy? J Matern Fetal Neonatal Med 2007; pp. 534–536
• 18. Ennever JF. Blue light, green light, white light, more light: treatment of neonatal jaundice. Clin Perinatol 1990;17:467-81
• 19. Sherbiny HS, Youssef DM, Sherbini AS, El-Behedy R, Sherief LM. High-intensity light-emitting diode vs fluorescent tubes for intensive phototherapy in neonates. Paediatr Int Child Health 2015;1-7
• 20. Tanyer G, Siklar Z, Dallar Y, Yildirmak Y, Tiraş U. Multiple dose IVIG treatment in neonatal immune hemolytic jaundice. J Trop Pediatr 2001;47:50–3
• 21. Demirel G, Akar M, Celik IH, Erdeve O, Uras N, Oguz SS, Dilmen U. Single versus multiple dose intravenous immunoglobulin in combination with LED phototherapy in the treatment of ABO hemolytic disease in neonates. Int J Hematol 2011; 93:700–7