Cargando…

Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease

The primary objective of this research was to evaluate the use of intravenous immunoglobulin (IVIG) in infants with hemolytic disease, to assess compliance with the American Academy of Pediatrics (AAP) guideline recommendations, and to review the data on which the guidelines were based. This retrosp...

Descripción completa

Detalles Bibliográficos
Autores principales: Mohan, Daniel R., Lu, Hannah, McClary, Jacquelyn, Marasch, Jaime, Nock, Mary L., Ryan, Rita M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047662/
https://www.ncbi.nlm.nih.gov/pubmed/36980054
http://dx.doi.org/10.3390/children10030496
_version_ 1785013981265526784
author Mohan, Daniel R.
Lu, Hannah
McClary, Jacquelyn
Marasch, Jaime
Nock, Mary L.
Ryan, Rita M.
author_facet Mohan, Daniel R.
Lu, Hannah
McClary, Jacquelyn
Marasch, Jaime
Nock, Mary L.
Ryan, Rita M.
author_sort Mohan, Daniel R.
collection PubMed
description The primary objective of this research was to evaluate the use of intravenous immunoglobulin (IVIG) in infants with hemolytic disease, to assess compliance with the American Academy of Pediatrics (AAP) guideline recommendations, and to review the data on which the guidelines were based. This retrospective study evaluated all infants in the NICU (neonatal intensive care unit) who received IVIG between January 2018 and December 2020 (n = 71). Total serum bilirubin (TSB) levels surrounding the time of IVIG administration, rate of rise of bilirubin, and direct antiglobulin test (DAT) status were evaluated to determine the appropriateness of IVIG use based on the 2004 AAP recommendations that was current at the time of the study. Fifty-nine infants received IVIG for hyperbilirubinemia. Of them, 80% had an ABO mismatch, 19% had Rh mismatch, and 71% were DAT-positive. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. One infant (1.6%) met all three AAP guideline criteria of being DAT-positive, bilirubin within 3 of exchange level, and rising bilirubin despite intensive phototherapy. Twenty-five (42%) babies were DAT positive and met one of the other two criteria. Only 12% (n = 7) had a bilirubin within 3 of exchange level. Most infants who received IVIG for hyperbilirubinemia did not meet the AAP criteria, prompting us to develop an institution-specific IVIG clinical practice guideline. The 2022 AAP guideline was published after our study was completed, but it confirmed our belief that IVIG usage should be more restricted and the criteria more explicit.
format Online
Article
Text
id pubmed-10047662
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-100476622023-03-29 Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease Mohan, Daniel R. Lu, Hannah McClary, Jacquelyn Marasch, Jaime Nock, Mary L. Ryan, Rita M. Children (Basel) Article The primary objective of this research was to evaluate the use of intravenous immunoglobulin (IVIG) in infants with hemolytic disease, to assess compliance with the American Academy of Pediatrics (AAP) guideline recommendations, and to review the data on which the guidelines were based. This retrospective study evaluated all infants in the NICU (neonatal intensive care unit) who received IVIG between January 2018 and December 2020 (n = 71). Total serum bilirubin (TSB) levels surrounding the time of IVIG administration, rate of rise of bilirubin, and direct antiglobulin test (DAT) status were evaluated to determine the appropriateness of IVIG use based on the 2004 AAP recommendations that was current at the time of the study. Fifty-nine infants received IVIG for hyperbilirubinemia. Of them, 80% had an ABO mismatch, 19% had Rh mismatch, and 71% were DAT-positive. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. One infant (1.6%) met all three AAP guideline criteria of being DAT-positive, bilirubin within 3 of exchange level, and rising bilirubin despite intensive phototherapy. Twenty-five (42%) babies were DAT positive and met one of the other two criteria. Only 12% (n = 7) had a bilirubin within 3 of exchange level. Most infants who received IVIG for hyperbilirubinemia did not meet the AAP criteria, prompting us to develop an institution-specific IVIG clinical practice guideline. The 2022 AAP guideline was published after our study was completed, but it confirmed our belief that IVIG usage should be more restricted and the criteria more explicit. MDPI 2023-03-02 /pmc/articles/PMC10047662/ /pubmed/36980054 http://dx.doi.org/10.3390/children10030496 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mohan, Daniel R.
Lu, Hannah
McClary, Jacquelyn
Marasch, Jaime
Nock, Mary L.
Ryan, Rita M.
Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease
title Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease
title_full Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease
title_fullStr Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease
title_full_unstemmed Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease
title_short Evaluation of Intravenous Immunoglobulin Administration for Hyperbilirubinemia in Newborn Infants with Hemolytic Disease
title_sort evaluation of intravenous immunoglobulin administration for hyperbilirubinemia in newborn infants with hemolytic disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047662/
https://www.ncbi.nlm.nih.gov/pubmed/36980054
http://dx.doi.org/10.3390/children10030496
work_keys_str_mv AT mohandanielr evaluationofintravenousimmunoglobulinadministrationforhyperbilirubinemiainnewborninfantswithhemolyticdisease
AT luhannah evaluationofintravenousimmunoglobulinadministrationforhyperbilirubinemiainnewborninfantswithhemolyticdisease
AT mcclaryjacquelyn evaluationofintravenousimmunoglobulinadministrationforhyperbilirubinemiainnewborninfantswithhemolyticdisease
AT maraschjaime evaluationofintravenousimmunoglobulinadministrationforhyperbilirubinemiainnewborninfantswithhemolyticdisease
AT nockmaryl evaluationofintravenousimmunoglobulinadministrationforhyperbilirubinemiainnewborninfantswithhemolyticdisease
AT ryanritam evaluationofintravenousimmunoglobulinadministrationforhyperbilirubinemiainnewborninfantswithhemolyticdisease