Cordero-González G, García-Graullera MG, Guzmán-Reyes LA, Salinas-Ramírez V, Fernández-Carrocera LA

Language: Spanish
References: 10
Page: 176-182
PDF size: 125.73 Kb.

ABSTRACT

Introduction: In many parts of the world, Rh hemolytic disease remains a significant cause of neonatal hyperbilirrubinemia and kernicterus. Exchange transfusion, aimed at preventing kernicterus, are useful but they are expensive and carry significant risks. Intravenous Immune Globulin (IVIG) administration to neonates with Rh hemolytic disease has been reported to decelerate hemolysis sufficiently to reduce exchange transfusions. However, we can find no general consensus regarding the use of IVIG for this conditions, and we can find no systematic reviews on which to base a consensus. We completed a meta-analyses of studies that were performed to determine whether administration of IVIG to neonates with Rh hemolytic disease reduces exchange transfusions. Material and methods: Guidelines set forth by the Cochrane Neonatal Collaborative Group were used. No language restrictions were applied. Only two relevant randomized, placebocontrolled, double-masked studies were identified. Exact methods were used for hypothesis testing. The relative risk (RR) and the 95% confidence interval (CI) were used to describe the magnitude of association between IVIG administration and exchange transfusions. Results: The studies involved an aggregate of 69 neonates; 35 IVIG and 34 placebo recipients. The analysis indicated that IVIG recipients had a lower risk of receiving an exchange transfusion; the exact estimation of RR was 0.42; 95% CI 0.23- 0.74; p = 0.0004. Conclusions: Administration of IVIG to neonates who have Rh hemolytic disease reduces exchange transfusions. We speculate that the benefit/risk ratio of IVIG administration to these patients is higher than the ratio for no IVIG administration. Therefore, we conclude that administering IVIG to neonates with Rh hemolytic disease is a rational consensus position.

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