背景:受同免疫性溶血性疾病(HDN)影响的新生儿有发展为严重高胆红素血症的风险。研究表明,胆红素水平的增加会影响新生儿的神经发育。为了避免与交换输血相关的并发症,静脉注射免疫球蛋白G(IVIG)用于治疗高胆红素血症。我们纳入了所有接受两剂以上IVIG治疗的同种免疫性溶血性疾病的婴儿。我们分析了与IVIG治疗相关的副作用的发生率和交换输血率。
方法:2011年10月至2022年10月在东卡罗来纳大学卫生部进行的回顾性图表审查确定了接受超过两剂IVIG治疗HDN的新生儿。月经后年龄大于28天的新生儿,接受少于3剂IVIG或接受其他适应症的IVIG被排除.不良事件的发生,人口统计学和其他药物治疗的使用进行了审查。
结果:病例系列包括11例新生儿。严重高胆红素血症的最常见原因是ABO不相容性。六名患者(54%)接受了三剂IVIG,5例患者(45%)接受四剂IVIG,胆红素水平低于换血.没有超过四剂IVIG的治疗报告,治疗期间也没有不良事件。
结论:在这个HDN新生儿队列中,多剂量IVIG治疗后胆红素水平下降。关于降低交换输血风险的IVIG最佳总剂量建议的未来研究。
UNASSIGNED: Neonates affected by isoimmune hemolytic disease (HDN) are at risk of developing severe hyperbilirubinemia. Studies show that increasing levels of bilirubin impact neonatal neurodevelopment. To avoid complications associated with exchange transfusion, intravenous immunoglobulin G (IVIG) is used to treat hyperbilirubinemia. We included all infants who received more than two doses of IVIG treatment for isoimmune hemolytic disease. We analyzed the incidence of side effects associated with IVIG treatment and the rate of exchange transfusion.
UNASSIGNED: A retrospective chart review performed between October 2011-October 2022 at East Carolina University Health identified neonates who received more than two doses IVIG for HDN. Neonates of postmenstrual age greater than 28 days old, receiving less than three doses of IVIG or received IVIG for other indications were excluded. The occurrences of adverse events, demographics and use of other medical therapies were reviewed.
UNASSIGNED: Eleven neonates were included in the
case series. Most common cause of severe hyperbilirubinemia was attributed to ABO incompatibility. Six patients (54%) received three doses of IVIG, and five patients (45%) received four doses of IVIG with bilirubin levels decreasing below exchange transfusion. No treatment exceeding four doses of IVIG was reported, nor adverse events during treatment.
UNASSIGNED: In this cohort of neonates with HDN, bilirubin levels decreased after treatment with multiple doses of IVIG. Future research on recommendations of optimal total number doses of IVIG to reduce the risk for exchange transfusion.