IVIg administration 12 hours after birth, Outcome 4 Top\up transfusions in 1st week per infant. 3.6 AnalysisComparison 3 Intravenous immunoglobulin (IVIg) in addition phototherapy versus phototherapy. 2017. We also looked research lists of included and excluded tests and relevant evaluations for further relevant studies. Selection criteria We regarded as all randomized and quasi\randomized controlled tests of IVIg in the treatment of alloimmune HDN. AZD-4320 Tests must have used predefined criteria for the use of IVIg and exchange transfusion therapy to be included. Data collection and analysis We used the standard methods of Cochrane and its Neonatal Review Group. We assessed studies for inclusion and two review authors individually assessed quality and extracted data. We discussed any variations of opinion to reach consensus. We contacted investigators for more or missing info. We determined risk percentage (RR), risk difference (RD) and quantity needed to treat for an additional beneficial end result (NNTB) for categorical results. We determined mean difference (MD) for continuous variables. We used GRADE criteria to assess the risk of bias for major outcomes and to summarize the level of evidence. Main results Nine studies with 658 babies fulfilled the inclusion criteria. Term and preterm babies with Rh or ABO (or both) incompatibility were included. The use of exchange transfusion decreased significantly in the immunoglobulin treated group (standard RR 0.35, 95% CI 0.25 to 0.49; standard RD \0.22, 95% CI \0.27 to \0.16; NNTB 5). The mean quantity of exchange transfusions per infant was also significantly reduced the immunoglobulin treated group (MD \0.34, 95% CI \0.50 to \0.17). However, sensitivity analysis by risk of bias showed that in the only two studies in which the treatment was masked by use of a placebo and end result assessment was blinded, the results differed; AZD-4320 AZD-4320 there was no difference in the need for exchange transfusions (RR 0.98, 95% CI 0.48 to 1 1.98) or quantity of exchange transfusions (MD \0.04, 95% CI \0.18 to 0.10). Two studies assessed long\term results and found no instances of kernicterus, deafness or cerebral palsy. Authors’ conclusions Although overall results display a significant reduction in the need for exchange transfusion in babies treated with IVIg, the applicability of the results is limited because of low to very low quality of evidence. Furthermore, the two studies at lowest risk of bias display no good thing about IVIg in reducing the need for and quantity of exchange transfusions. Based on these results, we have insufficient confidence in the effect estimate for good thing about IVIg to make even a fragile recommendation for the use of IVIg for the treatment of alloimmune HDN. Further studies are needed before the use of IVIg for the treatment of alloimmune HDN can be recommended, and should include blinding of the treatment by use of a placebo as well as sufficient sample size to assess the potential for severe adverse effects. Simple language summary Immunoglobulin for alloimmune hemolytic disease in newborns Review query Is definitely IVIg effective in reducing the need for exchange transfusion in newborns with alloimmune hemolytic disease of the newborn (HDN)?(Higgins 2011). The following items for risk of bias were assessed: random sequence generation, allocation concealment, NAV3 blinding of participants and staff, blinding of end result assessment, incomplete end result data, selective reporting and other sources of bias. Each item was ranked as ‘low risk of bias’, ‘unclear risk of bias’ or ‘high risk of bias.’ Any variations of opinion were discussed having a third blinded review author until consensus was reached. For selective reporting, we used the following criteria to rate a study as ‘low AZD-4320 risk of bias:’ for studies enrolling neonates with Rh or both Rh and ABO HDN: reporting (in paper or subsequent correspondence) at least one end result related to each of ET, bilirubin and top\up transfusion, plus adverse effects and hospitalization. for studies enrolling only neonates with ABO HDN: reporting (in paper or subsequent correspondence) at least one AZD-4320 end result?related to each of ET and bilirubin, plus adverse effects and hospitalization..
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