AUTHOR=Okulu Emel , Erdeve Omer , Kilic Ilknur , Olukman Ozgur , Calkavur Sebnem , Buyukkale Gokhan , Cetinkaya Merih , Ulubas Dilek , Demirel Nihal , Hanta Deniz , Ertugrul Sabahattin , Gultekin Nazli Dilay , Tuncer Oguz , Demir Nihat , Bilgin Leyla , Narli Nejat , Yildiz Duran , Terek Demet , Koroglu Ozge Altun , Seren Canan , Ozyazici Elif , Ozdemir Ramazan , Turgut Hatice , Narter Fatma , Akin Yasemin , Ozyazici Ahmet , Zenciroglu Aysegul , Asker Huseyin Selim , Gokmen Zeynel , Salihli Musa , Bulbul Ali , Zubarioglu Umut , Atasay Begum , Koc Esin , Turkish Neonatal Society IVIG Study Group , Mert Kurthan , Yaman Akan , Dizdar Evrim Alyamac , Uras Nurdan , Hekimoglu Berna , Arisoy Ayse Engin , Senel Yasemin , Ozek Eren , Ozdemir Hulya , Tekgunduz Kadir , Caner Ibrahim , Tanriverdi Sema , Sarici Dilek , Kislali F. Mehmet , Aliefendioglu Didem , Guzoglu Nilufer , Aydemir Cumhur , Celik Muhittin , Karagol Belma Saygili , Bayraktar Bilge , Sahin Suzan , Hirfanoglu Ibrahim Murat , Acunas Betul , Ozlu Ferda , Ecevit Ayse , Arcagok Cengiz , Tekin Neslihan , Ergin Hacer , Arslan Selda , Coban Asuman TITLE=Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion JOURNAL=Frontiers in Pediatrics VOLUME=10 YEAR=2022 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.864609 DOI=10.3389/fped.2022.864609 ISSN=2296-2360 ABSTRACT=Introduction

Intravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion.

Materials and Methods

This study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2–3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared.

Results

During the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups (p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group (p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group (p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group (p < 0.001 and p = 0.01, respectively).

Conclusion

In this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility.