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Abstract
Progressive hemolytic jaundice is conventionally treated with hydration, phototherapy, and exchange transfusion. Recent studies have demonstrated that use of intravenous immunoglobulin (IVIG) is a promising addition to the management of hemolytic anemia and jaundice.
The aim of this prospective randomized control study is to determine the effect of intravenous immunoglobulin (IVIG) in the treatment of hemolytic disease of the newborn due to Rh incompatability, and to compare the effect of two different dose regimen (0.5 gm/kg) and (1 gm/kg) with conventional therapy.
This study was carried out from the period of March 2009 to January 2010, and included 90 neonates with isoimmune hemolytic jaundice recruited from the neonatal intensive care unite in El Galaa hospital.
Patients were subjected to clinical examination and laboratory assessment. Statistical analysis was done to evaluate the different studied parameters.
Ninety neonates with hemolytic jaundice due to Rh incompatibility proved by positive direct antiglobulin test (Coombs’ test) enrolled in the study. The neonates were randomly assigned into 3 groups: group I (50 neonates) were treated by conventional method including phototherapy, and served as a control group, group IIa (25 neonates) and group IIb (15 neonates) received IVIG once in a dose of 0.5 gm/kg and 1gm/kg respectively in addition to conventional therapy.
Exchange transfusions were performed according to hour-specific serum bilirubin values guidlelines (A.A.P., 2004).
No significant difference was observed between the groups in the severity of neonatal jaundice, mode of delivery, mean birth weight, gestational age at delivery and laboratory parameters.
In the current study, the rise of bilirubin level was attenuated by intravenous immunoglobulin (IVIG); the rate of DROP in bilirubin level was significant especially at 24, 48 and 96 hours (P< 0.0001, <0.0001,0.003 respectively).
The duration of phototherapy was significantly shorter in the treatment group than in the conventional group (p = 0.05).
Our results showed decrease in the number of cases in need for exchange transfusion between the conventional group 22% and group IIa 8%, but the difference was not significant (P=0.20), also no significant decrease in number of cases in need for exchange transfusion between group IIa 8% and group IIb 0% (P=0.52).
The results also showed significant decrease in the duration of hospital stay between conventional group with mean of 5 days and 3 days for both intervention groups (P<0.0001), with no difference between both intervention groups (P>0.05).
The potential adverse effects of IVIG therapy are hemolysis and allergic reactions. However, no side effect was reported in our study.
In conclusion:
The use of IVIG is effective in treatment of cases of hemolytic jaundice due to Rh incompatibility, whereas the use of low dose IVIG (0.5 gm/kg) is as effective as HDIVIG (1 gm/kg) in reducing the duration of photherapy and hospital stay also frequency of exchange transfusion.