Intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease.

Abstract

OBJECTIVE:

The objective of this study was to assess whether the use of high-dose intravenous immunoglobulin (IVIG) in late-preterm and term newborns with severe isoimmune hemolytic jaundice caused by Rh and ABO incompatibility was a risk factor for necrotizing enterocolitis (NEC).

METHODS:

An observational, retrospective study that encompassed 16 years was conducted. A total of 492 liveborn infants who were of >or=34 weeks' gestation and had severe isoimmune hemolytic jaundice caused by Rh (n = 91) and ABO (n = 401) incompatibility and were treated with phototherapy were included in the study. IVIG (500 mg/kg over 2-4 hours) was indicated when total serum bilirubin level plus 2 points reached 85% of the cutoff value for performing exchange transfusion.

RESULTS:

A total of 167 (34%) infants received IVIG. NEC was diagnosed in 11 (2.2%) patients: 10 (6%) in the IVIG-treated group and 1 (0.3%) in the non-IVIG-treated group. Five patients required urgent operation, and 1 of them died as a result of massive intestinal necrosis. Another patient died 2 years later as a result of short bowel syndrome. In the multivariate analysis, cesarean delivery (odds ratio [OR]: 3.76 [95% confidence interval (CI): 1.10-12.90), Apgar test at 5 minutes (OR: 0.50 [95% CI: 0.40-0.64), and IVIG (OR: 31.66 [95% CI: 3.25-308.57]) were independent factors significantly associated with NEC.

CONCLUSIONS:

The use of high-dose IVIG for severe isoimmune hemolytic jaundice in late-preterm and term infants was associated with a higher incidence of NEC.

• Authors: Josep Figueras-Aloy, José M Rodríguez-Miguélez, Martin Iriondo-Sanz, María-Dolores Salvia-Roiges, Francesc Botet-Mussons, Xavier Carbonell-Estrany
• Journal: Pediatrics (Pediatrics) Vol. 125 Issue 1 Pg. 139-44 (Jan 2010) ISSN: 1098-4275 [Electronic] United States
• PMID: 19948572 (Publication Type: Comparative Study, Journal Article)

Chemical References

• ABO Blood-Group System
• Immunoglobulins, Intravenous

Topics

• ABO Blood-Group System
• Blood Group Incompatibility (diagnosis)
• Confidence Intervals
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Enterocolitis, Necrotizing (chemically induced, epidemiology, physiopathology)
• Erythroblastosis, Fetal (diagnosis, drug therapy)
• Female
• Follow-Up Studies
• Humans
• Immunoglobulins, Intravenous (adverse effects, therapeutic use)
• Incidence
• Infant, Newborn
• Infant, Premature
• Male
• Odds Ratio
• Probability
• Retrospective Studies
• Severity of Illness Index
• Spain
• Survival Analysis
• Term Birth