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目的探讨晚期早产儿及足月儿使用大剂量静脉丙种球蛋白(IVIG)治疗严重ABO溶血病是否是引起坏死性小肠结肠炎(NEC)的危险因素。方法回顾性分析2009—2010年我院新生儿科收治胎龄≥34周的ABO溶血病患儿,所有患儿均接受光疗,如果血清总胆红素达光疗失败换血水平,给予IVIG0.5～1g/kg,4h内匀速输入,比较应用IVIG与未应用IVIG患儿及发生NEC与未发生NEC患儿母亲和自身的相关因素,Logistic回归分析发生NEC的危险因素。结果共有223例ABO溶血病患儿纳入研究,其中有48例患儿接受IVIG。223例ABO溶血病患儿中共有6例发生NEC(2.7%,6/223),其中未用IVIG组发生2例(1.1%,2/175),均为NECⅡA级;应用IVIG组发生4例(8.3%,4/48),均发生在应用IVIG后72h内,其中NECⅡA级3例,ⅡB级1例。Logistic回归分析显示,应用IVIG(OR=9.557)、小于胎龄儿(OR=7.932)、5minApgar评分低(OR=1.929)是引起ABO溶血病患儿发生NEC的独立危险因素。结论晚期早产及足月ABO溶血病新生儿使用IVIG可能增加发生NEC的危险性。
Objective To investigate whether high dose intravenous gamma globulin (IVIG) for treatment of severe ABO hemolytic disease in late preterm and term infants is a risk factor for necrotizing enterocolitis (NEC). Methods A retrospective analysis of neonates with ABO hemolytic disease of gestational age ≥34 weeks from 2009 to 2010 in our hospital was performed. All children underwent phototherapy. If serum total bilirubin reached the level of transfusion, then given IVIG 0.5 ~ 1g / kg and 4h respectively. Logistic regression analysis was used to analyze the risk factors for NEC in IVIG patients and non-IVIG infants and mothers and their non-NEC children. Results A total of 223 children with ABO hemolytic disease were included in the study, 48 of whom received IVIG. Six of 223 children with ABO hemolytic disease developed NEC (2.7%, 6/223), of which 2 (1.1%, 2/175) were non-IVIG patients and all were NECⅡA; 4 patients (8.3%, 4/48), all of which occurred within 72 hours after the application of IVIG, including 3 cases of NECⅡA and 1 case of ⅡB. Logistic regression analysis showed that using IVIG (OR = 9.557), less gestational age (OR = 7.932), low 5minApgar score (OR = 1.929) was an independent risk factor for NEC in children with ABO hemolytic disease. Conclusion The use of IVIG in neonates with advanced preterm and term ABO hemolytic disease may increase the risk of developing NEC.