| BackgroundHemolytic disease of newborn(HDN)is a common clinical disease and the main cause of pathological jaundice in early neonates.In severe cases,bilirubin encephalopathy can even be complicated.In recent years,intravenous immunoglobulin(IVIG)in the treatment of HDN has been considered to have a significant effect,and has been widely used clinically.However,more and more evidence show that IVIG treatment of HDN can increase the risk of necrotizing enterocolitis(NEC)in newborns.The mechanism is not clear,and it may be related to the increasing blood viscosity caused by the infusion of immunoglobulin and hemolysis caused by the destruction of red blood cells whcih can release a large amount of substances.Then it can affect the mesenteric blood flow and further causing mesenteric ischemia and hypoxia.Therefore,early observation of neonatal intestinal blood flow changes after IVIG treatment is important.NIRS is a non-invasive technique that dynamically monitors regional tissue oxygen saturation(rSO2)and reflects local blood flow perfusion.Earlier studies verified that NIRS monitoring of abdominal regional oxygen saturation(A-rSO2)in newborns can reflect intestinal tissue perfusion and oxygen supply,and a decrease in A-rSO2 can prompt early bowel hypoperfusion.Therefore,this article uses NIRS to monitor the changes of A-rSO2 in HDN newborns during IVIG treatment,in order to explore the effects of IVIG and hemolysis on intestinal blood flow.Objetives1.Preliminary to understand the early gut oxygenation in neonates with HDN;2.To explore the effects of IVIG application and infusion time on gut oxygenation in neonates with HDN.Materials and MethodsIn Chapter 1,from April 1,2019 to January 20,2020 in the Department of Neonatal Medicine,late preterm infants and term infants were eligible for enrollement in the study including 39 cases in the non-hemolytic group,and 23 cases without IVIG treatment in the hemolytic group.A-rSO2 monitoring was performed on the subjects for 3 days.A-rSO2 at different ages was compared between the two groups of newborns,and the changes of gut oxygenation of newborns with hemolytic disease were analyzed.In Chapter 2,from April 1,2019 to January 20,2020 in the Department of Neonatal Medicine,34 late preterm infants and term infants with HDN in the treatment of IVIG were eligible for enrollement in the study.According to the infusion time,all cases was divided into 15 in the 6-hour infusion group and 19 in the 8-hour infusion group.The subjects were monitored for about 20 hours from 2 hours before to 8 hours after the infusion.To analyze the changes of abdominal tissue oxygenation during infusion and the effect of infusion time on A-rSO2.ResultsIn Chapter 1,A-rSO2 in the observation group fluctuated between 50 and 87%within 3 days,with an average value of 72±10%,and there was no significant difference.Compared with the control group at each day,there was also no significant difference;In Chapter 2,A-rSO2 in newborns with HDN of 2 hours before infusion,during infusion,2,4,6,and 8 hours after infusion were 72±11%,71±10%,64±15%,66±12%,69± 10%,72±9%respectively.Compared with 2 hours before infusion,A-rSO2 significantly decreased at 2 hours after infusion(P=0.010).In the 6h group,compared with 2h before infusion,A-rSO2 decreased significantly from 0 to 2h after infusion(P=0.035)and from 2 to 4h after infusion(P=0.015);In the 8h group:compared with 2h before infusion,A-rSO2 was significantly reduced at 2h after infusion(P=0.046).Conclusion1.The results showed that A-rSO2 in early and mild hemolytic neonates is relatively stable;A single hemolytic factor may have limited effect on intestinal perfusion;2.A-rSO2 decreased first and then increased before and after immunoglobulin infusion,and decreased to the lowest value within 2h after infusion.The increase of A-rSO2 in the 6h infusion group was delayed compared to the 8h infusion group.Considering that the infusion time may affect the recovery of A-rSO2. |
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