Meta analysis of the effect of immunoglobulin infusion on neonatal isoimmune hemolytic disease caused by blood group incompatibility / 中华儿科杂志

ABSTRACT

<p><b>OBJECTIVE</b>Neonatal isoimmune hemolytic disease is still one of the major causes of neonatal hyperbilirubinemia. The infants with severe hemolysis even need phototherapy and exchange transfusion. Early intravenous immunoglobulin infusion may block hemolysis to some extent. This study aimed to investigate the efficacy and safety of immunoglobulin infusion on neonatal isoimmune hemolytic disease by meta analysis.</p><p><b>METHOD</b>All randomized controlled trials on the effect of immunoglobulin infusion on neonatal Rh and ABO incompatible hemolytic disease obtained by searching MEDLINE, Cochrane Library, EMBASE, CNKI and CBM were included. Meta analysis was done by Review Manager 4.2 software.</p><p><b>RESULTS</b>Six trials with totally 456 neonates were included. There were 109 infants with Rh blood group incompatible hemolysis in 4 studies and 347 infants with ABO blood group incompatible hemolysis in 4 studies. There was no significant difference in gestational age, weight and sex between the immunoglobulin infusion and control groups. Compared with those neonates treated with only phototherapy, the infants treated with immunoglobulin and phototherapy had shorter duration of phototherapy (weighted mean difference, WMD -15.42, 95%CI -29.00 to -1.85), less chance to be given exchange transfusion (RR 0.25, 95%CI 0.17 to 0.39) and shorter duration of hospitalization (WMD -25.44, 95%CI -36.93 to -13.94). While intravenous immunoglobulin could not decrease the maximum serum bilirubin level (WMD -29.91, 95%CI -78.24 to 18.42). There was no significant difference in the incidence of late anemia between the two groups. No adverse reaction was found in neonates who received immunoglobulin.</p><p><b>CONCLUSIONS</b>The results of this meta analysis support that the intravenous immunoglobulin had some therapeutic effect on neonatal isoimmune hemolytic disease. The infants who received immunoglobulin had shorter duration of phototherapy and less chance to be given exchange transfusion. Well designed, double blind and randomized controlled trials with large sample size and long-term follow-up are needed for further evaluation of the efficacy and safety of the immunoglobulin therapy.</p>