RESUMO
Neonatal jaundice resulting from immunological hemolysis is not uncommon. While it is possible to prevent a large number of Rh-isoimmune hemolytic diseases by administration of specific anti-D immunoglobulins to the mother, the prevention of incompatibility in the ABO groups is not feasible. In spite of advances made in the use of phototherapy, and in order to avoid kernicterus, the treatment of these jaundices can require one or several exchange transfusions (ET), a therapy which is not devoid of risk. For some time now, the data concerning the efficiency of high-dose intravenous immunoglobulin therapy (HDIIT) in the treatment of these jaundices have been increasing. A review of the literature shows that, if used as soon as possible in newborn infants over 32 weeks of gestation age, afflicted with Rh or ABO hemolytic disease, the HDIIT brings about, with no undesirable side effects, a significant decrease in the ET number as well as a significant reduction in the length of phototherapy and hospitalization. The data suggesting that HDIIT could increase the risk of late transfusion is open to controversy.
Assuntos
Anemia Hemolítica Autoimune/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Icterícia Neonatal/tratamento farmacológico , Isoimunização Rh/complicações , Isoimunização Rh/tratamento farmacológico , Anemia Hemolítica Autoimune/imunologia , Eritroblastose Fetal/tratamento farmacológico , Medicina Baseada em Evidências , Humanos , Recém-Nascido , Icterícia Neonatal/imunologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoAssuntos
Doenças do Prematuro , Dermatopatias , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Candidíase Cutânea/diagnóstico , Candidíase Cutânea/tratamento farmacológico , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Idade Gestacional , Hemangioma/congênito , Hemangioma/diagnóstico , Humanos , Doença Iatrogênica , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Fototerapia/efeitos adversos , Esclerema Neonatal/diagnóstico , Dermatopatias/congênito , Dermatopatias/diagnóstico , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/diagnósticoRESUMO
"Bronze baby" syndrome is a rare complication of phototherapy for neonatal jaundice occurring due to modified liver function, particularly cholestasis, of various origins. We report a case which occurred in a premature infant who developed a grey-brown coloration during phototherapy. The infant had haemolytic jaundice due to Rhesus incompatibility complicated by cholestasis of thick bile fluid. Abnormal accumulation of unexcreted photoproducts due to the cholestasis appeared to be the cause of the bronze coloration. The clinical course was favourable and the skin coloration returned to normal a few weeks after the end of the phototherapy. It is essential to identify the underlying liver disease in order to determine the prognosis of this syndrome.