Is intravenous immunoglobulin superior to exchange transfusion in the management of hyperbilirubinaemia in term neonates?

A 36-week 3550 g neonate is admitted to the intensive care unit and commenced on intensive phototherapy for known Rhesus haemolytic disease. In spite of intensive phototherapy, the bilirubin level approaches the exchange transfusion threshold by hour 16 of life. The specialist registrar orders a crossmatch of blood and arranges for central line insertion in preparation for an exchange transfusion. The new registrar queries why intravenous immunoglobulin is not being used first in an attempt to avoid exchange transfusion.

Structured clinical question

In a term infant with immune haemolytic disease of the newborn [patient] does intravenous immunoglublin [therapy] reduce serum bilirubin (SBR) levels effectively and avoid exchange transfusion [outcome]?

Search strategy and outcome

Search date: August 2008.

Secondary search

Cochrane Library (2002). One relevant systematic review.

Primary search

Pubmed and Medline 1951–2008; Embase 1974–2008; Cinahl 1982–2008 using Dialog Datastar.

Search terms: [Neonatal hyperbilirubinaemia or hyperbilirubinaemia AND neonate or hyperbilirubinaemia and newborn] AND [ intravenous immunoglobulin or immunoglobulin]. Limit to newborn, human and English language.

Commentary

Haemolytic disease of the newborn (HDN) is an isoimmune haemolytic jaundice which prior to modern interventions had a perinatal mortality rate of 50% that has now decreased to 7 per 100 000 births.1 The mainstay of treatment is intensive phototherapy …