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Tijdschrift voor kindergeneeskunde

, Volume 71, Issue 4, pp 111–115 | Cite as

Intraveneuze immunoglobulinen ter preventie van wisseltransfusie bij neonatale immuunhemolytische ziekte

  • P. Van de Voorde
  • G. Hendrickx
  • L. Goossens
  • A. Zecic
  • P. Vanhaesebrouck
Artikelen
  • 16 Downloads

Samenvatting

De conventionele behandeling van neonatale hyperbilirubinemie bestaat uit fototherapie en zo nodig wisseltransfusie (wt). Recente publicaties postuleren intraveneuze immunoglobulinen (ivig) als therapeutisch alternatief bij significante hemolytische icterus. Vanaf 1996 behandelden wij twintig patiënten met ernstige immuunhemolytische ziekte. ivig-behandeling werd ingesteld volgens de ‘klassieke’ wt-criteria (Klaus & 38; Fanaroff): navelstrengbilirubine > 85 μmol/l (1 mg/dl = 17 μmol/l) en hemoglobine < 10 g/dl of totaalserumbilirubine (tbr) > 170 μmol/l binnen de eerste 24 levensuren, > 255 μmol/l de tweede 24 uur en > 340 μmol/l nadien. Negentien patiënten voldeden uiteindelijk aan deze criteria. Eén patiënt overleed vroegtijdig. Bij twee werd een wt verricht voor ivig-toediening. Deze patiënten werden uitgesloten van de studie. Eén neonaat vertoonde, ondanks twee doses ivig, progressief oplopende tbr-waarden zodat een ‘rescue’-wt noodzakelijk werd geacht. Aldus werd bij vijftien van de zestien patiënten een wisseltransfusie vermeden. Er werden geen majeure complicaties gezien. Vijf patiënten vertoonden laattijdige anemie met bloedtransfusienood. Toediening van intraveneuze immunoglobulinen is een veilige en effectieve behandeling van immuunhemolytische icterus. Gezien de brede variatie in ernst lijkt het definiëren van criteria voor therapie obligaat.

Summary

Conventional treatment for neonatal hyperbilirubinemia includes phototherapy and exchange transfusion (et) if necessary. Recent publications postulate intravenous immunoglobulins (ivig) as a therapeutic alternative for significant haemolytic jaundice. From 1996 we treated twenty patients with severe immune haemolytic disease. Ivig treatment was initiated according to ‘standard’ et criteria (Klaus & 38; Fanaroff): cord bilirubin > 85 μmol/l (1 mg/dl = 17 μmol/l) and hemoglobin < 10 g/dl or total serum bilirubin (tbr) > 170 μmol/l within 24 hours after birth, 255 μmol/l the second 24 hours and 340 μmol/l thereafter. Nineteen patients eventually fulfilled these criteria. One infant died early. In two, ivig was given only after et was performed, so they were excluded for further evaluation. One patient did not respond and a ‘rescue’ et after two doses of ivig was considered necessary. In fifteen out of sixteen remaining patients this procedure could be avoided. No major side effects were seen. Five patients developed late anaemia which required a top-up transfusion. It is concluded that ivig is a safe and effective treatment for immune haemolytic jaundice. In view of the large spectrum in severity defining criteria for treatment seems mandatory.

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Copyright information

© Bohn Stafleu van Loghum 2003

Authors and Affiliations

  • P. Van de Voorde
    • 1
  • G. Hendrickx
  • L. Goossens
  • A. Zecic
  • P. Vanhaesebrouck
  1. 1.

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