Slide 1                                                     © 2003 By Default!‘ROLE OF IVIG IN THE MANAGEMENT OFNEONATAL I...
Slide 2                                                     © 2003 By Default!                             INTRODUCTION   ...
Slide 3                                                                        © 2003 By Default!NONPHYSIOLOGIC JAUNDICE I...
Slide 4                                                     © 2003 By Default!                                       WHY W...
Slide 5                                                     © 2003 By Default!    CONVENTIONAL MANAGEMENT   Intensive pho...
Slide 6                                                     © 2003 By Default!           EXCHANGE TRANSFUSION             ...
Slide 7                                                     © 2003 By Default!COMPLICATIONS OF EXCHANGE       TRANSFUSION ...
Slide 8                                                         © 2003 By Default!  IVIG IN HDN -AAP GUIDELINES           ...
Slide 9                                                                            © 2003 By Default!                     ...
Slide 10                                                     © 2003 By Default!                           WHY THIS STUDY  ...
Slide 11                                                     © 2003 By Default!                    AIMS & OBJECTIVES      ...
Slide 12                                                                         © 2003 By Default!                 MATERI...
Slide 13                                                     © 2003 By Default!             MATERIAL & METHODS            ...
Slide 14                                                     © 2003 By Default!             MATERIAL & METHODS     INTENS...
Slide 15                                                     © 2003 By Default!AAP GUIDELINES FOR PHOTOTHERAPY            ...
Slide 16                                                          © 2003 By Default!      AAP GUIDELINES FOR EXCHANGE     ...
Slide 17                                                     © 2003 By Default!                         OBSERVATIONS  A Fr...
Slide 18                                                       © 2003 By Default!                       SEX DISTRIBUTION  ...
Slide 19                                                     © 2003 By Default!                                       GEST...
Slide 20                                                     © 2003 By Default!                                           ...
Slide 21                                                     © 2003 By Default!                        INCOMPATIBILITY  A ...
Slide 22                                                     © 2003 By Default!                                  BIRTH ORD...
Slide 23                                                     © 2003 By Default!         H/O JAUNDICE IN SIBLING  A Free sa...
Slide 24                                                                                      © 2003 By Default!       SER...
Slide 25                                                     © 2003 By Default!      CULTURE-POSITIVE SEPSIS  A Free sampl...
Slide 26                                                                 © 2003 By Default!PARENTRAL FLUIDS & ANTIBIOTICSA...
Slide 27                                                                          © 2003 By Default!     DURATION & COST O...
Slide 28                                                                                  © 2003 By Default!              ...
Slide 29                                                     © 2003 By Default!                                   CONCLUSI...
Slide 30                                                                  © 2003 By Default!                              ...
Slide 31                                                          © 2003 By Default!     HOUR-SPECIFIC BILIRUBIN NOMOGRAM ...
Slide 32                                                                    © 2003 By Default!             TIMING OF FOLLO...
Slide 33                                                     © 2003 By Default!            THANK YOU  A Free sample backgr...
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Role of IVIG in the management of neonatal isoimmune hemolytic jaundice

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Role of IVIG in the management of neonatal isoimmune hemolytic jaundice

  1. 1. Slide 1 © 2003 By Default!‘ROLE OF IVIG IN THE MANAGEMENT OFNEONATAL ISOIMMUNE HEMOLYTICJAUNDICE’ MEETA SACHDEV G.MALINI, P.N.AGRAWAL, S.M.DEWANGAN DEPTT. OF PEDIATRICS JLN HOSPITAL & RESEARCH CENTRE BHILAI A Free sample background from www.awesomebackgrounds.com
  2. 2. Slide 2 © 2003 By Default! INTRODUCTION  Neonatal jaundice: Common in 1st wk of life  60% of term & 80% of preterm infants.  Clinical jaundice: Bilirubin >7 mg/dl.  Mostly physiologic A Free sample background from www.awesomebackgrounds.com
  3. 3. Slide 3 © 2003 By Default!NONPHYSIOLOGIC JAUNDICE IN WELL INFANT  Hemolytic disease of newborn (ABO/Rh)  Incidence of ABO incompatibility : 25% significant jaundice : 2.5%  Incidence of Rh incompatibility : 4.8% significant jaundice : 0.17 – 0.31% Gupte et al. Natl Med J India 1994; 7: 65-66 A Free sample background from www.awesomebackgrounds.com
  4. 4. Slide 4 © 2003 By Default! WHY WORRY Clinically indistinguishable Bilirubin rises to toxic levels Acute bilirubin encephalopathy Left with sequelae- KERNICTERUS Athetosis, sensorineural deafness, intellectual deficits A Free sample background from www.awesomebackgrounds.com
  5. 5. Slide 5 © 2003 By Default! CONVENTIONAL MANAGEMENT Intensive phototherapy (excretion by alternative pathways) Maintain hydration & increase feeds (decreases enterohepatic circulation) Exchange transfusion (mechanical removal) A Free sample background from www.awesomebackgrounds.com
  6. 6. Slide 6 © 2003 By Default! EXCHANGE TRANSFUSION Prerequisites Invasive procedure Trained personnel Well-equipped setup Sepsis screen & blood culture Parentral fluids & prophylactic antibiotics Near- fatal complications(5%) & mortality (1%) A Free sample background from www.awesomebackgrounds.com
  7. 7. Slide 7 © 2003 By Default!COMPLICATIONS OF EXCHANGE TRANSFUSION  RISK OF EXPOSURE TO BLOOD  COMPLICATIONS OF UVC  Hypocalcaemia , hypomagnesaemia, hyperkalemia  Hypoglycemia, acid-base disturbances  Cardiovascular, apnea, seizures  Bleeding, hemolysis  Infection  Misc- hypo/hyperthermia, NEC. Etc. A Free sample background from www.awesomebackgrounds.com
  8. 8. Slide 8 © 2003 By Default! IVIG IN HDN -AAP GUIDELINES (Pediatrics 2004;114:297-316) Indication: Hemolytic disease of newborn with significant hyperbilirubinemia Dose: 0.5-1gm/kg Mode of administration: Infusion given over 2-4 hrs. Monitoring: For adverse reactions A Free sample background from www.awesomebackgrounds.com
  9. 9. Slide 9 © 2003 By Default! Y Y Y Y YY Y Maternal YFetal RBC Antibodies MECHANISM OF IVIG Blockade Y Y RE cell IVIG Y Y FcImmunoglobulin Lysis of RBC A Free sample background from www.awesomebackgrounds.com
  10. 10. Slide 10 © 2003 By Default! WHY THIS STUDY  After publication of AAP guidelines, IVIG is being used more frequently in HDN.  Is IVIG useful only to bring down the bilirubin level ?  Are there any more advantages?  What is our experience? A Free sample background from www.awesomebackgrounds.com
  11. 11. Slide 11 © 2003 By Default! AIMS & OBJECTIVES  To evaluate the efficacy of IVIG in HDN  To compare the stay, cost of treatment & complications between IVIG & Exchange group  Which is safer? A Free sample background from www.awesomebackgrounds.com
  12. 12. Slide 12 © 2003 By Default! MATERIAL & METHODS TYPE OF STUDY : OBSERVATIONAL TIME FRAME : JAN 2010 – DEC 2011 NO. OF SUBJECTS : 16(16) INCLUSION CRITERIA : Healthy neonates (>35wks), HDN & significant hyperbilirubinemia EXCLUSION CRITERIA : Sick neonates & gestation <35 wks. A Free sample background from www.awesomebackgrounds.com
  13. 13. Slide 13 © 2003 By Default! MATERIAL & METHODS  Blood grouping of infants whose mother’s blood group is O/Rh negative  Close monitoring for clinical jaundice  Measurement of serum bilirubin levels A Free sample background from www.awesomebackgrounds.com
  14. 14. Slide 14 © 2003 By Default! MATERIAL & METHODS  INTENSIVE PHOTOTHERAPY & Maintain hydration  INTRAVENOUS IMMUNOGLOBULIN INFUSION : Rising bilirubin level despite intensive phototherapy OR bilirubin levels were within 2-3 mg % of exchange levels  EXCHANGE TRANSFUSION : Bilrubin level >5mg% of exchange threshold A Free sample background from www.awesomebackgrounds.com
  15. 15. Slide 15 © 2003 By Default!AAP GUIDELINES FOR PHOTOTHERAPY (Pediatrics 2004;114:297-316) A Free sample background from www.awesomebackgrounds.com
  16. 16. Slide 16 © 2003 By Default! AAP GUIDELINES FOR EXCHANGE TRANSFUSION (Pediatrics 2004;114:297-316) A Free sample background from www.awesomebackgrounds.com
  17. 17. Slide 17 © 2003 By Default! OBSERVATIONS A Free sample background from www.awesomebackgrounds.com
  18. 18. Slide 18 © 2003 By Default! SEX DISTRIBUTION Female : male = 1.28: 1 A Free sample background from www.awesomebackgrounds.com
  19. 19. Slide 19 © 2003 By Default! GESTATION A Free sample background from www.awesomebackgrounds.com
  20. 20. Slide 20 © 2003 By Default! WEIGHT A Free sample background from www.awesomebackgrounds.com
  21. 21. Slide 21 © 2003 By Default! INCOMPATIBILITY A Free sample background from www.awesomebackgrounds.com
  22. 22. Slide 22 © 2003 By Default! BIRTH ORDER A Free sample background from www.awesomebackgrounds.com
  23. 23. Slide 23 © 2003 By Default! H/O JAUNDICE IN SIBLING A Free sample background from www.awesomebackgrounds.com
  24. 24. Slide 24 © 2003 By Default! SERUM BILIRUBIN LEVELS Peak bilirubin After After After Mean value 24 hrs 48 hrs 72 hrs (Age in days) 16.31 13.16 9.95 19.53 IVIG (2.5 Days) p < 0.005 p< 0.001 p < 0.001 Significant Highly significant Highly significant 18.82 13.23 9.68 Exchange 25.09transfusion (3.75 Days) p < 0.001 p < 0.001 p < 0.001 Highly significant Highly significant Highly significant A Free sample background from www.awesomebackgrounds.com
  25. 25. Slide 25 © 2003 By Default! CULTURE-POSITIVE SEPSIS A Free sample background from www.awesomebackgrounds.com
  26. 26. Slide 26 © 2003 By Default!PARENTRAL FLUIDS & ANTIBIOTICSANCILLARY EXCHANGE IVIGTREATMENT TRANSFUSION IV FLUIDS 3 (19%) 16 (100%) First line 3 (19%) 0ANTIBIOTICS Broad spectrum 2 (13%) 9 (56%) Extended spectrum 0 7 (44%) 2-5 D 5 (31%) 4 (25%)DURATION OF 6-10 D 0 4 (25%)ANTIBIOTICS 11-14 D A Free sample background from www.awesomebackgrounds.com 0 8 (50%)
  27. 27. Slide 27 © 2003 By Default! DURATION & COST OF T/T Blood exchange p valueMEAN VALUES IVIG group group (Unpaired T test) Significance DURATION OF 5.5 Days 4.5 DaysPHOTOTHERAPY p > 0.05 Not significantHOSPITAL STAY 7.2 Days 9.6 Days p < 0.05 Significant COST ( Rs) 13,500 22,200 p < 0.005 Highly significant A Free sample background from www.awesomebackgrounds.com
  28. 28. Slide 28 © 2003 By Default! ADVERSE EFFECTS IN EXCHANGE TRANSFUSION 100% 80%% of patients 60% 44% 40% 25% 19% 19% 20% 13% 0% 0% A Free sample background from www.awesomebackgrounds.com
  29. 29. Slide 29 © 2003 By Default! CONCLUSION  Predicting the risk of severe jaundice, close monitoring & follow-up is crucial in ABO & Rh incompatibility  Early intervention with intensive phototherapy & IVIG is helpful in averting exchange transfusion, its associated risks & complications significantly  Duration of stay & cost of treatment is significantly reduced A Free sample background from www.awesomebackgrounds.com
  30. 30. Slide 30 © 2003 By Default! REFERENCES Alcock GS, Liley H. Immunoglobulin infusion for isoimmune hemolytic jaundice in neonates (review). Cochrane Database Syst Rev 2001;(4) Vinayaka G et al. role of intravenous immunoglobulin in the management of hemolytic disease of newborn. Pediatrics Today Vol XII No. 6,2009 Alpay F et al. High dose intravenous immunoglobulin therapy in neonatal immune hemolytic jaundice. Acta Pediatr 1999;88:216-119 Patra K. Adverse effects associated with neonatal exchange transfusion in the 1990s. J Pediatr 2004;144:626-31 Mukhopadhyay K et al.Intravenous immunoglobuin in rhesus hemolytic disease. Indian J Pediatr 2003;70:697-9 Miqdad AM et al. IVIG therapy for significant hyperbilirubinemia in ABO hemolytic background from www.awesomebackgrounds.com Matern Fetal Neonatal Med 2004;16:163-6 A Free sample disease of newborn. J
  31. 31. Slide 31 © 2003 By Default! HOUR-SPECIFIC BILIRUBIN NOMOGRAM (Bhutani VK, et al.Pediatrics 1999;103:6-14) A Free sample background from www.awesomebackgrounds.com
  32. 32. Slide 32 © 2003 By Default! TIMING OF FOLLOW-UP (Pediatrics 2004;114:297-316) Infant discharged follow-up by Before age 24 h 72 h Between 24 & 48 h 96 h Between 48 & 72 h 120 h A Free sample background from www.awesomebackgrounds.com
  33. 33. Slide 33 © 2003 By Default! THANK YOU A Free sample background from www.awesomebackgrounds.com
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