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. 2022 Apr 28:10:864609.
doi: 10.3389/fped.2022.864609. eCollection 2022.

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

Emel Okulu  1 , Omer Erdeve  1 , Ilknur Kilic  2 , Ozgur Olukman  3 , Sebnem Calkavur  3 , Gokhan Buyukkale  4 , Merih Cetinkaya  4 , Dilek Ulubas  5 , Nihal Demirel  5   6 , Deniz Hanta  7 , Sabahattin Ertugrul  8 , Nazli Dilay Gultekin  9 , Oguz Tuncer  10 , Nihat Demir  10 , Leyla Bilgin  11 , Nejat Narli  12 , Duran Yildiz  13 , Demet Terek  14 , Ozge Altun Koroglu  14 , Canan Seren  15 , Elif Ozyazici  15 , Ramazan Ozdemir  16 , Hatice Turgut  16 , Fatma Narter  17 , Yasemin Akin  17 , Ahmet Ozyazici  18 , Aysegul Zenciroglu  18 , Huseyin Selim Asker  19 , Zeynel Gokmen  20 , Musa Salihli  20 , Ali Bulbul  21 , Umut Zubarioglu  21 , Begum Atasay  1 , Esin Koc  22 ; Turkish Neonatal Society IVIG Study Group
Collaborators, Affiliations

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

Emel Okulu et al. Front Pediatr. .

Abstract

Introduction: Intravenous 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 methods: This 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.

Results: During 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).

Conclusion: In 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.

Keywords: ABO incompatibility; exchange transfusion; hemolytic disease of the newborn; intravenous immunoglobulin; light-emitting diode; phototherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flowchart of the study.
Figure 2
Figure 2
Intravenous immunoglobulin (IVIG) has no advantage in avoiding exchange transfusion, rehospitalization, and neurological sequelae (p = 0.001, <0.001, and 0.01, respectively).
See this image and copyright information in PMC

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