ABO Hemolitik Hastalığı Olan Yenidoğan Bebeklerde İntravenöz İmmunglobulin G (IVIG) Kullanımının Klinik Sonuçlar Üzerine Etkisi
Öz
Amaç: ABO hemolitik hastalık yenidoğan döneminde en sık görülen alloimmün hemolitik hastalıktır. Hemolitik hastalıklara bağlı gelişen sarılık varlığında geleneksel tedavi yöntemleri fototerapi ve kan değişimi olmakla birlikte hemolizin önlenmesi için intravenöz immunglobulin G (IVIG) tedavisi de kullanılmaktadır. Bu çalışma ile ABO hemolitik hastalığı olan yenidoğan bebeklerde IVIG kullanımının klinik sonuçalar üzerine etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Gebelik yaşı 37 hafta ve üzerinde, direkt coombs testi pozitif olan, indirekt hiperbilirubinemi nedeniyle fototerapi tedavisi başlanan 192 bebek çalışmaya dahil edildi. Enzim eksikliği (G6PD), polisitemi, viseral kanama, sefal hematom, patolojik tartı kaybı, metabolik hastalık ve sepsis şüphesi olan bebekler çalışmaya alınmadı. Bebekler sadece fototerapi alan ve fototerapi tedavisine ek IVIG tedavisi alan bebekler olarak iki grupta retrospektif olarak incelendi. Bulgular: Bebeklerin ortalama gebelik yaşları ve doğum tartıları benzerdi. IVIG uygulanan bebeklerde fototerapi ve hastanede yatış süreleri anlamlı olarak uzun, doğumdaki hemoglobin ve hematokrit değerlerine göre taburculuk değerlerinde gözlenen düşme (Δ Hemoglobin ve Δ Hematokrit) IVIG uygulanmayan gruba göre anlamlı olarak yüksek bulundu. Hemoliz bulguları devam ettiği için tekrar doz IVIG tedavisi alan bebeklerde ise en yüksek bilirubin düzeyleri ve toplam fototerapi süresi açısından tek doz IVIG tedavisi alan gruba göre anlamlı fark saptanmadı. Tartışma: Bu çalışma ile yenidoğanların ABO hemolitik hastalığında fototerapi tedavisine ek olarak IVIG kullanımının hemolizi önlemediği, fototerapi ve hastanede yatış süresini kısaltmadığı gösterilmiş, tekrarlanan dozlarda IVIG uygulamasının klinik etki olarak tek doz IVIG uygulamasından üstün olmadığı saptanmıştır. ABO hemolitik hastalığa bağlı gelişen indirekt hiperbilirubinemi tedavisinde halen ilk tercih etkin uygulanan fototerapi olmalıdır. ABO hemolitik hastalıkta IVIG kullanımını önermek için geniş hasta sayılı prospektif çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Destekleyen Kurum
yoktur
Kaynakça
- 1. Beken S, Hirfanoglu I, Turkyilmaz C, Altuntas N, Unal S, Turan O, et al. Intravenous immunoglobulin G treatment in ABO hemolyic disease of the newborn, is it myth or real? Indian J Hematol Blood Transfus 2014;30(1):12-5. doi: 10.1007/s12288-012-0186-3. google scholar
- 2. Pan J, Zhan C, Yuan T, Chen X, Ni Y, Shen Y, et al. Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study. J Perinatol 2021;41:1397- 402. doi: 10.1038/s41372-021-00963-5. google scholar
- 3. Okulu E, Erdeve O, Kilic I, Olukman O, Calkavur S, Buyukkale G, et al. Intravenous immunoglobulin use in hemolytic disease due to ABO incompatibility to prevent exchange transfusion. Turkish Neonatal Society IVIG Study Group. Front Pediatr 10:864609. doi: 10.3389/fped.2022.864609. google scholar
- 4. Al-lawama M, Badran E, Elrimawi A, Mustafa AB, Alkhatib H. Intravenous immunoglobulins as adjunct treatment to phototherapy in isoimmune hemolytic disease of the newborn: A retrospective case-control study. J Clin Med Res 2019;11(11):760-3. doi: 10.14740/jocmr4003. google scholar
- 5. American Academy of Pediatrics Subcommittee on H. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316. doi: 10.1542/peds.114.1.297. google scholar
- 6. Alpay F, Sarıcı SU, Okutan V, Erdem G, Ozcan O, Gökcay E. Highdose intravenous immunglobulin therapy in neonatalimmune haemolytic jaundice. Acta Paediatr 1999;88(2):216-9. doi: 10.1080/08035259950170420. google scholar
- 7. Zwiers C, Scheffer-Rath ME, Lopriore E, de Haas M, Liley HG. Immunoglobulin for alloimmune hemolytic disease in neonates. Cochrane Database Syst Rev 2018;3:CD003313. doi: 10.1002/14651858.CD003313.pub2. google scholar
- 8. Lieberman L, Spradbrow J, Keir A, Dunn M, Lin Y, Callum J. Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11-year study. Transfusion 2016;56:2704– 11. doi: 10.1111/trf.13721. google scholar
- 9. Figueras-Aloy J, Rodriguez-Miguelez JM, Iriondo-Sanz M, Salvia- Roiges MD, Botet-Mussons F, Carbonell-Estrany X. Intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease. Pediatrics 2010;125:139-44. doi: 10.1542/ peds.2009-0676. google scholar
- 10. Çoban A, Türkmen M, Gürsoy T. Türk Neonatoloji Derneği Yenidoğan Sarılıklarında Yaklaşım, İzlem ve Tedavi Rehberi. 2014. Available at https://www.neonatology.org.tr google scholar
- 11. Kaplan M, Merlob P, Regev R. Israel guidelines for the management of neonatal hyperbilirubinemia and prevention of kernicterus. J Perinatol 2008;28:389-97. doi: 10.1038/jp.2008.20. google scholar
- 12. National Collaborating Centre for Women’s and Children’s Health(UK). Neonatal Jaundice. London: RCOG Press; 2010 May. google scholar
- 13. Matteocci A, De Rosa A, Buffone E, Pierelli L. Retrospective analysis of HDFN due to ABO incompatibility in a single institution over 6 years. Transfus Med 2019;29:197-201. doi: 10.1111/tme.12512. google scholar
- 14. Yaseen H, Khalaf M, Rashid N, Darwich M. Does prophylactic phototherapy prevent hyperbilirubinemia in neonates with ABO incompatibility and positive coombs test? J Perinatol 2005;25:590– 594. doi: 10.1038/sj.jp.7211356. google scholar
- 15. Gottstein R, Cooke RWI. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed 2003;88:F6-F10. doi: 10.1136/fn.88.1.f6. google scholar
- 16. 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;45:653-9. google scholar
- 17. Miqdad AM, Abdelbasit OB, Shaheed MM, Seidahmed MZ, Abomelha AM, Arcala OP. Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med 2004;16:163-6. doi: 10.1080/14767050400009873. google scholar
- 18. Demirel G, Akar M, Celik IH, Erdeve OH, Uras N, Oguz SS et al. Single versus multiple dose intravenous immunoglobulin in combination with LED phototherapy in the treatment of ABO hemolytic disease in neonates. Int J Hematol 2011;93:700-3. doi: 10.1007/s12185- 011-0853-4. google scholar
- 19. Tanyer G, Sıklar Z, Dallar Y, Yıldırmak Y, Tıras U. Multiple döşe IVIG treatment in neonatal immune hemolytic jaundice. J Trop Pediatr 2001;47(1):50-3. doi: 10.1093/tropej/47.1.50. google scholar
- 20. Hakan N, Zenciroglu A, Aydin M, Okumus N, Dursun A, Dilli D. Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey. J Matern Fetal Neonatal Med 2015;28:1537-41. doi: 10.3109/14767058.2014.960832. google scholar
- 21. Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality. Pediatrics 2007;120:27- 32. doi: 10.1542/peds.2006-2910. google scholar
Öz
Objective: The ABO hemolytic disease is the most common alloimmune hemolytic disease in the neonatal period. The conventional treatment strategies for indirect hyperbilirubinemia caused by hemolysis are phototherapy and exchange transfusion. IVIG can also be used to prevent hemolysis. This study aimed to evaluate the efficacy of IVIG use in infants with ABO hemolytic disease. Materials and Method: Infants with gestational age >37 weeks, with a positive direct Coombs test, and having phototherapy for indirect hyperbilirubinemia were included in the study (n=192). Enzyme deficiency (G6PD), polycythemia, visceral hemorrhage, pathological weight loss and septicemia were the exclusion criteria. The newborn infants were reviewed retrospectively in two groups as the only phototherapy group and the phototherapy and IVIG group. Results: The mean gestational age and birth weight of the infants were similar between groups. The hospital stay and phototherapy duration were significantly longer and hemoglobin decrease from birth to discharge was significantly higher in the phototherapy and IVIG group. There was no difference found between the infants who received one dose or recurrent doses of IVIG in terms of highest bilirubin level and total phototherapy duration. Conclusion: This study showed that IVIG use in ABO hemolytic disease of newborns in addition to phototherapy neither prevents hemolysis nor decreases phototherapy duration and hospital stay. Recurrent doses of IVIG treatment have no clinical benefit over single dose IVIG treatment. The first choice of treatment should be an effective phototherapy in indirect hyperbilirubinemia due to ABO hemolytic disease. Further larger prospective studies are needed to assess the IVIG use in ABO hemolytic disease.
Anahtar Kelimeler
Kaynakça
- 1. Beken S, Hirfanoglu I, Turkyilmaz C, Altuntas N, Unal S, Turan O, et al. Intravenous immunoglobulin G treatment in ABO hemolyic disease of the newborn, is it myth or real? Indian J Hematol Blood Transfus 2014;30(1):12-5. doi: 10.1007/s12288-012-0186-3. google scholar
- 2. Pan J, Zhan C, Yuan T, Chen X, Ni Y, Shen Y, et al. Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study. J Perinatol 2021;41:1397- 402. doi: 10.1038/s41372-021-00963-5. google scholar
- 3. Okulu E, Erdeve O, Kilic I, Olukman O, Calkavur S, Buyukkale G, et al. Intravenous immunoglobulin use in hemolytic disease due to ABO incompatibility to prevent exchange transfusion. Turkish Neonatal Society IVIG Study Group. Front Pediatr 10:864609. doi: 10.3389/fped.2022.864609. google scholar
- 4. Al-lawama M, Badran E, Elrimawi A, Mustafa AB, Alkhatib H. Intravenous immunoglobulins as adjunct treatment to phototherapy in isoimmune hemolytic disease of the newborn: A retrospective case-control study. J Clin Med Res 2019;11(11):760-3. doi: 10.14740/jocmr4003. google scholar
- 5. American Academy of Pediatrics Subcommittee on H. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316. doi: 10.1542/peds.114.1.297. google scholar
- 6. Alpay F, Sarıcı SU, Okutan V, Erdem G, Ozcan O, Gökcay E. Highdose intravenous immunglobulin therapy in neonatalimmune haemolytic jaundice. Acta Paediatr 1999;88(2):216-9. doi: 10.1080/08035259950170420. google scholar
- 7. Zwiers C, Scheffer-Rath ME, Lopriore E, de Haas M, Liley HG. Immunoglobulin for alloimmune hemolytic disease in neonates. Cochrane Database Syst Rev 2018;3:CD003313. doi: 10.1002/14651858.CD003313.pub2. google scholar
- 8. Lieberman L, Spradbrow J, Keir A, Dunn M, Lin Y, Callum J. Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11-year study. Transfusion 2016;56:2704– 11. doi: 10.1111/trf.13721. google scholar
- 9. Figueras-Aloy J, Rodriguez-Miguelez JM, Iriondo-Sanz M, Salvia- Roiges MD, Botet-Mussons F, Carbonell-Estrany X. Intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease. Pediatrics 2010;125:139-44. doi: 10.1542/ peds.2009-0676. google scholar
- 10. Çoban A, Türkmen M, Gürsoy T. Türk Neonatoloji Derneği Yenidoğan Sarılıklarında Yaklaşım, İzlem ve Tedavi Rehberi. 2014. Available at https://www.neonatology.org.tr google scholar
- 11. Kaplan M, Merlob P, Regev R. Israel guidelines for the management of neonatal hyperbilirubinemia and prevention of kernicterus. J Perinatol 2008;28:389-97. doi: 10.1038/jp.2008.20. google scholar
- 12. National Collaborating Centre for Women’s and Children’s Health(UK). Neonatal Jaundice. London: RCOG Press; 2010 May. google scholar
- 13. Matteocci A, De Rosa A, Buffone E, Pierelli L. Retrospective analysis of HDFN due to ABO incompatibility in a single institution over 6 years. Transfus Med 2019;29:197-201. doi: 10.1111/tme.12512. google scholar
- 14. Yaseen H, Khalaf M, Rashid N, Darwich M. Does prophylactic phototherapy prevent hyperbilirubinemia in neonates with ABO incompatibility and positive coombs test? J Perinatol 2005;25:590– 594. doi: 10.1038/sj.jp.7211356. google scholar
- 15. Gottstein R, Cooke RWI. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed 2003;88:F6-F10. doi: 10.1136/fn.88.1.f6. google scholar
- 16. 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;45:653-9. google scholar
- 17. Miqdad AM, Abdelbasit OB, Shaheed MM, Seidahmed MZ, Abomelha AM, Arcala OP. Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med 2004;16:163-6. doi: 10.1080/14767050400009873. google scholar
- 18. Demirel G, Akar M, Celik IH, Erdeve OH, Uras N, Oguz SS et al. Single versus multiple dose intravenous immunoglobulin in combination with LED phototherapy in the treatment of ABO hemolytic disease in neonates. Int J Hematol 2011;93:700-3. doi: 10.1007/s12185- 011-0853-4. google scholar
- 19. Tanyer G, Sıklar Z, Dallar Y, Yıldırmak Y, Tıras U. Multiple döşe IVIG treatment in neonatal immune hemolytic jaundice. J Trop Pediatr 2001;47(1):50-3. doi: 10.1093/tropej/47.1.50. google scholar
- 20. Hakan N, Zenciroglu A, Aydin M, Okumus N, Dursun A, Dilli D. Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey. J Matern Fetal Neonatal Med 2015;28:1537-41. doi: 10.3109/14767058.2014.960832. google scholar
- 21. Steiner LA, Bizzarro MJ, Ehrenkranz RA, Gallagher PG. A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality. Pediatrics 2007;120:27- 32. doi: 10.1542/peds.2006-2910. google scholar
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Çocuk Sağlığı ve Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2022 |