Direkt Coombs Pozitif ABO Uygunsuzluğunda Doğum Sonrası 12. Saatte Bilirubin Persentilinin Profilaktik İntravenöz İmmünglobülin Kullanımında Belirleyici Rolü

Yıl 2009, Cilt: 9 Sayı: 1, 22 - 24, 01.01.2009

Fatma Narter Müferret Ergüven

Öz

Amaç: Kordon kanında direkt Coombs pozitif ABO uygunsuzluğu olan yenidoğanlarda 12. saat total bilirubin düzeyi ile ciddi hiperbilirubinemi riskini ve erken intravenöz immünglobülin IVIG tedavisi gereksinimini değerlendirmek. Yöntem: Hastanemizde 1 Kasım 2007-19 Şubat 2008 tarihleri arasında doğan, anne bebek arasında ABO uygunsuzluğu olup, kordon kanında direkt Coombs pozitif olan 21 yenidoğanda doğum sonrası 12. saatte total bilirubin ölçülüp, bilirubin risk eğrisine göre ciddi hiperbilirubinemi gelişme riski saptandı. Risk bölgelerine göre fototerapi ve IVIG tedavisi oranları belirlendi. Bulgular: ABO uygunsuzluğu olan 57 yenidoğanın 21’inde % 36.8 kordon kanında direkt Coombs pozitif saptandı. Total bilirubin, bilirubin risk eğrisine göre % 19.1 vakada 40. persentilin altında, % 23.8 vakada 40-75. persentil arasında, % 23.8 vakada 75-95. persentil arasında, % 33.3 vakada 95. persentilin üzerindeydi. İzlemde yüksek risk bölgesinde olanların n:7 tümünde, orta-yüksek riskte olanların n:5 birinde olmak üzere toplam sekiz vakaya fototerapi uygulandı. Fototerapi alanların beşine aynı zamanda IVIG tedavisi de uygulandı. Sonuç: ABO uyunsuzluğu olan yenidoğanlarda kordon kanında direkt Coombs bakılması ve pozitif olanlarda 12. saatte total bilirubin ölçülmesinin ciddi ABO hemolitik hastalığının erken tanısında değerli olabileceği düşünülmüştür

Anahtar Kelimeler

Hiperbilirubinemi, yenidoğan, ABO uygunsuzluğu

The Role of 12th Hour Bilirubin Percentile in Direct Coombs Positive ABO Incompatible Newborn Infants in the Use of Prophylactic Intravenous Immunoglobulin

Öz

Aim: To investigate the risk of serious hyperbilirubinemia and the requirement for early intravenous immunoglobulin G IVIG treatment using twelfth-hour total serum bilirubin levels in ABO-incompatible newborns who had positive direct Coombs test. Methods: This clinical study was conducted in 21 newborn babies with ABO incompatibility and who were direct Coombs positive. The total bilirubin level was measured twelve hours after birth and the risk of significant hyperbilirubinemia was predicted using the bilirubin risk zones. Phototherapy and IVIG treatment needs were identified based on the risk levels. Results: Of the 57 newborn babies with ABO incompatibility, 21 were direct Coombs positive. 19.1 % of the babies had total bilirubin levels below 40th percentile, 23.8 % had bilirubin levels between 40-75th percentile, 23.8 % bilirubin levels between 75-95th percentile, and 33,3 % had total bilirubin levels over 95th percentile. Photherapy was needed in 8 patients including all patients from the high-risk category n:7 and one patient from the moderate risk category n:5 . IVIG treatment was also given to 5 babies who received phototherapy. Conclusions: It is suggested that newborn babies with ABO incompatibility should be tested for direct Coombs tests in their cord blood. If the result is positive, measurement of total bilirubin level 12 hours after birth could be a valuable predictor of ABO hemolytic disease.

Anahtar Kelimeler

Hyperbilirubinemia, newborn, ABO incompatibility

Kaynakça

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