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Neonatal Intensive Care Drug Manual
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| bet | 302/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Evidence summary
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Efficacy:
Newborn infants with isoimmunisation: Systematic review included 12 studies, 10 trials (n = 463) of Rh isoimmunisation and 2 trials (n = 350) of ABO isoimmunisation. Studies with a high risk of bias showed that IVIg reduced the rate of exchange transfusion (ET) in Rh isoimmunisation (RR 0.23, 95% CI 0.13 to 0.40), whereas studies with a low risk of bias that also used prophylactic phototherapy did not show statistically significant differences (RR 0.82, 95% CI 0.53 to 1.26). [1, 2] (LOE ,I GOR C) For ABO isoimmunisation, only studies with a high risk of bias were available and meta-analysis revealed efficacy of IVIg in reducing ET (RR 0.31, 95% CI 0.18 to 0.55). Role of IVIg in ABO disease is not clear.[1, 3] (LOE I, GOR C)
Recommendations: The National Blood Authority Patient Blood Management Guidelines for Neonatal and Paediatrics: In neonates with haemolytic disease of the fetus and newborn, the use of IVIg is not recommended.[4]
However, the NICE Practice Guideline recommends: use intravenous immunoglobulin 500 mg/kg over 4 hours as an adjunct to continuous intensified phototherapy in cases of rhesus haemolytic disease or ABO haemolytic disease when the serum bilirubin continues to rise by more than 8.5 µmol/litre per hour [5]. The AAP Subcommittee on Hyperbilirubinemia Clinical Practice Guideline 2004 recommends: In infants with isoimmune haemolytic disease and TSB level rising in spite of intensive phototherapy or within 2–3 mg/dL (34–51 µmol/L) of exchange level, administer intravenous immunoglobulin 0.5–1 g/kg over 2 hours and repeat in 12 hours if necessary.[6]
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