Intravenous Immunoglobulin G for Hemolytic Disease of the Newborn: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LI Maojun ,  CHEN Changhui , WU qing , SHI wei , YANG Qian , LI Mengni

Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan, China;

Corresponding author：

CHEN Changhui, Email: chen966888@yahoo.com.cn

Keywords：

Newborn; Hemolytic disease; Intravenous immunoglobulin; Randomized controlled trial; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20100570

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Objective 　To assess the effectiveness of intravenous immunoglobulin G (IVIG) in reducing the need for exchange transfusion in neonates with proven haemolytic disease due to Rh and/or ABO incompatibility. To evaluate the effectiveness of IVIG in reducing the duration of phototherapy and hospital stay.
Methods 　We electronically searched CENTRAL, MEDLINE (1966 to May 2008), EMBASE (1992 to May 2008), CBMdisc (November 1979 to May 2008), and also checked the reference lists of all papers identified. According to the Cochrane Handbook for Systematic Reviews of interventions, randomized controlled trials comparing IVIG and phototherapy with phototherapy alone in neonates with Rh and/or ABO incompatibility were identified and analyzed.
Results 　Six RCTs were included. The meta-analysis showed that, IVIG can significantly decrease the requirements of exchange transfusion (RR=0.27, 95%CI 0.18 to 0.42), the duration of hospitalization (WMD= –1.11, 95%CI –1.60 to –0.63) and the duration of phototherapy (WMD= –0.82, 95%CI –1.16 to –0.47).
Conclusions 　Intravenous immunoglobulin (IVIG) is recommended for treating hemolytic disease of the newborn because it is effective in decreasing the requirements of exchange transfusion, the duration of hospitalization and phototherapy. Well designed studies with large sample in multi-center are required for further proving.

Citation： LI Maojun,CHEN Changhui,WU qing,SHI wei,YANG Qian,LI Mengni. Intravenous Immunoglobulin G for Hemolytic Disease of the Newborn: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(10): 1199-1204. doi: 10.7507/1672-2531.20100570 Copy

1.	Maisels JM. Neonatal jaundice. Ped in Rev, 2006, 27(12): 443-454.
2.	Bhutani VK, Johnson L. Kernicterus in the 21st century: frequently asked questions. Journal of Perinatology, 2009, 29: S20-S24.
3.	Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med, 2008, 358(9): 920-928.
4.	Newman TB, Liljestrand P, Jeremy RJ, et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med, 2006, 354(18): 1889-900.
5.	Williams Y, Lynch S, McCann S, et al. Correlation of platelet Fc gammaRIIA polymorphism in refractory idiopathic (immune) thrombocytopenic purpura. Br J Haematol, 1998, 101(4): 779-782.
6.	Rosse WF, Hillmen P, Schreiber AD. Immune-mediated hemolytic anemia. Hematology Am Soc Hematol Educ Program, 2004, 48-62.
7.	American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 2004, 114(1): 297-316.
8.	Gottstein R, Cooke RW. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed, 2003, 88(1): F6-F10.
9.	Alcock GS, Liley H. Systematic review: Immunoglobulin infusion for isoimmune haemolytic jaundice in neonates. Cochrane Database Syst Rev, 2002, (3): CD003313.
10.	Alpay F, Sarici SÜ, Okutan V, et al. High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice. Acta Paediatr, 1999, 88(2): 216-219.
11.	Dagoglu T, Ovali F, Samaci N, et al. High-dose intravenous immunoglobulin therapy for rhesus haemolytic disease. J Int Med Res, 1995, 23(4): 264-271.
12.	Rübo J, Albrecht K, Lasch P, et al. High-dose intravenous immuneglobulin therapy for hyperbilirubinemia caused by Rh hemolytic disease. J Pediatr, 1992, 121(1): 93-97.
13.	Voto LS, Sexer H, Ferreiro G, et al. Neonatal administration of high-dose intravenous immunoglobulin in rhesus hemolytic disease. J Perinat Med, 1995, 23(6): 443-451.
14.	Miqdad AM, Abdelbasit OB, Shaheed MM, et al. Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med, 2004, 16(3): 163-166.
15.	Nasseri F, Mamouri GA, Babaei H. Intravenous immunoglobulin in ABO and Rh hemolytic diseases of newborn. Saudi Med J, 2006, 27(12): 1827-1830.
16.	Tanyer G, SiklarZ, Dallar Y, et al. Multiple dose IVIG treatment in neonatal immune hemolytic jaundice. J Trop Pediatr, 2001, 47(1): 50-53.
17.	Girish G, Chawla D, Agarwal R, et al. Efficacy of two dose regimes of intravenous immunoglobulin in Rh hemolytic disease of newborn--a randomized controlled trial. Indian Pediatr, 2008, 45(8): 653-659.

1. Maisels JM. Neonatal jaundice. Ped in Rev, 2006, 27(12): 443-454.
2. Bhutani VK, Johnson L. Kernicterus in the 21st century: frequently asked questions. Journal of Perinatology, 2009, 29: S20-S24.
3. Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med, 2008, 358(9): 920-928.
4. Newman TB, Liljestrand P, Jeremy RJ, et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med, 2006, 354(18): 1889-900.
5. Williams Y, Lynch S, McCann S, et al. Correlation of platelet Fc gammaRIIA polymorphism in refractory idiopathic (immune) thrombocytopenic purpura. Br J Haematol, 1998, 101(4): 779-782.
6. Rosse WF, Hillmen P, Schreiber AD. Immune-mediated hemolytic anemia. Hematology Am Soc Hematol Educ Program, 2004, 48-62.
7. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 2004, 114(1): 297-316.
8. Gottstein R, Cooke RW. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed, 2003, 88(1): F6-F10.
9. Alcock GS, Liley H. Systematic review: Immunoglobulin infusion for isoimmune haemolytic jaundice in neonates. Cochrane Database Syst Rev, 2002, (3): CD003313.
10. Alpay F, Sarici SÜ, Okutan V, et al. High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice. Acta Paediatr, 1999, 88(2): 216-219.
11. Dagoglu T, Ovali F, Samaci N, et al. High-dose intravenous immunoglobulin therapy for rhesus haemolytic disease. J Int Med Res, 1995, 23(4): 264-271.
12. Rübo J, Albrecht K, Lasch P, et al. High-dose intravenous immuneglobulin therapy for hyperbilirubinemia caused by Rh hemolytic disease. J Pediatr, 1992, 121(1): 93-97.
13. Voto LS, Sexer H, Ferreiro G, et al. Neonatal administration of high-dose intravenous immunoglobulin in rhesus hemolytic disease. J Perinat Med, 1995, 23(6): 443-451.
14. Miqdad AM, Abdelbasit OB, Shaheed MM, et al. Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med, 2004, 16(3): 163-166.
15. Nasseri F, Mamouri GA, Babaei H. Intravenous immunoglobulin in ABO and Rh hemolytic diseases of newborn. Saudi Med J, 2006, 27(12): 1827-1830.
16. Tanyer G, SiklarZ, Dallar Y, et al. Multiple dose IVIG treatment in neonatal immune hemolytic jaundice. J Trop Pediatr, 2001, 47(1): 50-53.
17. Girish G, Chawla D, Agarwal R, et al. Efficacy of two dose regimes of intravenous immunoglobulin in Rh hemolytic disease of newborn--a randomized controlled trial. Indian Pediatr, 2008, 45(8): 653-659.

Chinese Journal of Evidence-Based Medicine

Intravenous Immunoglobulin G for Hemolytic Disease of the Newborn: A Systematic Review

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