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IS INTRAVENOUS IMMUNOGLOBULIN EFFECTIVE TO REDUCE EXCHANGE TRANSFUSION IN RHESUS HAEMOLYTIC DISEASE OF THE NEWBORN?
Immunoglobulin and Newborn Infant
Erythroblastosis Therapy
Randomized Clinical Trial and Immunoglobulin
Imunoglobulinas e Recém-Nascido
Ensaio Clínico Controlado Aleatório e Imunoglobulinas
Afiliação
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Resumo em Inglês
Background Haemolytic disease of the newborn (HDN) is a persistent public health
problem in Brazil due to the lack of efficient prophylactic measures. The standard
therapeutic interventions for the newborn are phototherapy and exchange transfusion
(ET). Intravenous immunoglobulin has been used for several years in some
neonatal centres to reduce the need for ET among newborns with jaundice, but the
scientific evidence on the efficacy of this treatment is still not definitive.
Objective To assess the evidence of efficacy of non-specific immunoglobulin in
decreasing the need for ET in newborns with haemolytic disease of the newborn.
Methods All randomized controlled trials on the use of intravenous immunoglobulin
(IVIG) to reduce the need of ET in the treatment of Rhesus haemolytic disease
were included by searching MEDLINE, Cochrane Library, EMBASE, Scopus, Lilacs,
Scielo, www.clinicaltrial.gov and abstracts from SPR.
Results Six trials were found including 281 neonates: Rubo et al. (1992) (32); Alpay
et al. (1999) (23); Dagoglu et al. (1995) (41); Nasseri et al. (2006) (13); Santos et
al. (2010) (92); Smits-Wintjens et al. (2011) (80). Most of the trials used the immunoglobulin
in a prophylactic approach and only one used it when the jaundice was
already established. Only two studies used placebo in the control group and
described a method of blinding the intervention after allocation. The phototherapy
protocols were not the same neither the efficacy of the units used. There was difference
on the doses of the IVIG and on the number of infusions.
Conclusions Although current guidelines support the therapeutic effect of the
intravenous immunoglobulin effect on decreasing the need for ET in newborns with
Rhesus haemolytic disease it shall not yet be routinely recommended.
Palavras-chave em inglês
Rh Hemolytic Disease of the NewbornImmunoglobulin and Newborn Infant
Erythroblastosis Therapy
Randomized Clinical Trial and Immunoglobulin
DeCS
Eritroblastose FetalImunoglobulinas e Recém-Nascido
Ensaio Clínico Controlado Aleatório e Imunoglobulinas
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