| Objective:To study the significance of reticulocyte percentage for intravenous immunoglobulin use in newborns diagnosed with neonatal ABO hemolytic disease.Methods:A prospective analysis method was used,70 patients with neonatal ABO hemolytic disease(reticulocyte percentage was less than or equal to 6%)were included in this study,who were admitted to the Department of Pediatrics of the First Affiliated Hospital of Kunming Medical University between October 2019 and April 2020.They were divided into non-IVIG group and IVIG group according to the tail number of the hospital case number.The odd-numbered neonates in non-IVIG group only received basic treatment such as phototherapy,the even-numbered neonates in IVIG group were administered by intravenous immunoglobulin at the same time with phototherapy,and neonates-with non-hemolytic hyperbilirubinemia wrer divided into the control group in the same period.The clinical datas of newborns in each group during pregnancy and postnatal period were collected,including the days(after birth)at the onset of jaundice,days at admission,total bilirubin,direct bilirubin,indirect bilirubin,albumin,hemoglobin,reticulocyte percentage,neutrophil percentage,C-reactive protein,and hemoglobin and reticulocyte percentage 4-7 days after treatment.The differences in hospitalization time,total bilirubin peak,hemoglobin,and percentage of reticulocytes and the incidence of related complications were compared between the IVIG group and the non-IVIG group.Results:A total of 126 neonates diagnosed with neonatal ABO hemolytic disease during the study period were found to have early occurrence and/or rapid progression of jaundice after birth.After the three items of serum hemolysis examination were refined and the neonatal ABO hemolytic disease was definitely diagnosed,the neonates were transferred to our neonatal department.35 patients had reticulocyte percentage greater than 6%and anemia,another 21 patients failed to complete a hemoglobin and reticulocyte reexamination due to unplanned discharge for family reasons were excluded from the research.A total of 70 hemolytic newborns were included in the study,including 35 newborns in the IVIG group and 35 newborns in the non-IVIG group.67 newborns were the Han nationality,2 newborns were the Yi nationality and 1 newborn was the Dai nationality.The maternal age ranged from 21 to 45 years,with an average age of 31.3 ± 4.6 years.The maternal age in IVIG and non-IVIG group were 31.1 ±4.2 years and 31.5± 5.1 years respectively;33 newborns were male and 37 newborns were female,and 16 males and 19 females in IVIG group,percentage were 45.7%and 54.3%respectively,17 males and 18 females in the non-IVIG group,percentage were 48.5%and 51.5%respectively;4 newborns in the IVIG group were cesarean sections,and 8 newborns in the non-IVIG group were cesarean sections;The birth weight(g)of the IVIG group and the non-IVIG group were 3093.7±315.2,3122.4± 302.2,respectively;the admission weight(g)of the IVIG group and the non-IVIG group were 2977.5± 324.3,3005.0±3298.5,respectively;26 newborns in the IVIG group had blood type A,23 newborns in the non-IVIG group had blood type A,9 newborns in the IVIG group had blood type B,and 12 newborns in the non-IVIG group had blood type B;31 newborns in the IVIG group had positive antibody release tests and 30 newborns in the non-IVIG group had positive antibody release tests,4 and 5 newborns had weak positive antibody release tests respectively;the age(hours)of newborns when jaundice appeared in the IVIG group and the non-IVIG group were 18.7 ± 7.5 and 22.2 ± 9.0 respectively;the age(hours)of newborns when admitted to the hospital in the IVIG group and the non-IVIG group were 37.2 ± 15.6 and 42.6 ±15.5,respectively;total bilirubin(umol/L)at admission of the IVIG and non-IVIG groups were 151.4 ± 43.6 and 169.1± 46.7,respectively;direct bilirubin in the IVIG and non-IVIG groups(umol/L)were 10.6 ± 4.7 and 11.7 ± 6.6 respectively;indirect bilirubin(umol/L)in the IVIG group and non-IVIG group were 140.7 ± 44.0 and 167.9± 60.0,respectively;albumin(g/L)in the IVIG group and non-IVIG group were 32.6 ±2.4 and 34.0 ± 2.3,respectively;hemoglobin(g/L)in the IVIG and non-IVIG groups were 164.6 ± 18.2 and 170.0± 20.7,respectively;the percentage of reticulocytes in the IVIG and non-IVIG groups were 4.6±0.8 and 4.4± 0.7,respectively;the percentage of neutrophils in the IVIG and non-IVIG groups were 59.7 ± 11.8 and 59.6 ± 7.2,respectively;the C-reactive protein(mg/L)in the IVIG and non-IVIG groups were 3.8± 4.3 and 3.0±3.1,respectively;When reexaminationing hemoglobin(g/L)4-7 days after treatment,the IVIG group and non-IVIG group were 148.4 ± 18.5 and 154.6 ±17.0,respectively;and the reticulocyte percentage in the IVIG group and non-IVIG group were 2.3±0.9 and 1.9± 0.6;The duration of hospital stay(days)in the IVIG group and the non-IVIG group were 5.8 ± 1.9 and 5.1 ± 1.4,respectively;the peak percutaneous bilirubin(mg/dL)during the hospitalization period in the IVIG and non-IVIG groups were 14.4 ± 2.3 and 14.9± 2.2,respectively.There were 74 cases of non-hemolytic neonatal hypeibilirubinemia,of which 3.9 were male and 35 were females.18 newborns were born by cesarean section.The age of newborns when jaundice was appeared was 38.4±15.4 hours,the age at the time of admission was 80.7 ± 25.1 hours.At the time of admission,the blood cell analysis and the determination of bilirubin and albumin were immediately improved.The total bilirubin(umol/L)was 292.6±50.2,the total number of white blood cells(109/L)was 11.1 ± 3.9,the red blood cell count(1012/L)was 4.9±0.6,and the percentage of reticulocyte was 3.5 ± 1.2,C-reactive protein(Mg/L)was 4.4 ±5.4.For hemolytic neonates,the duration of hospital stay in the IVIG group was 5.8±1.9 days,the peak percutaneous bilirubin was 14.4±2.3 mg/dL,the peak time of bilirubin occurred was 4.6±1.5 days,and the decrease in hemoglobin was 16.1±10.1 g/L,the minimum value of hemoglobin was 108 g/L,the decrease in reticulocyte pencentage was 2.2±0.7,the minimum value of reticulocyte pencentage was 0.9.no related complications such as bilirubin encephalopathy occurred during hospitalization.The duration of hospital stay in the non-IVIG group was 5.1 ± 1.4 days,the peak percutaneous bilirubin was 14.9±2.2mg/dL,the peak time of bilirubin occurred was 4.8±1.1 days,and the decrease in hemoglobin was 15.3±12.4 g/L,the minimum value of hemoglobin was 125 g/L,the decrease in reticulocyte pencentage was 2.4±0.8,the minimum value of reticulocyte pencentage was 0.6,and also no related complications such as bilirubin encephalopathy occurred during hospitalization.Conclusion(s):1.The percentage of reticulocytes in the hemolytic group were significantly higher than those in newborn with non-hemolytic hyperbilirubinemia;2.For neonatal ABO hemolytic disease with a reticulocyte percentage of less than or equal to 6%,the use of IVIG might not reduce the peak bilirubin and shorten the duration of hospital stay. |
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