International guidelines regarding the role of IVIG in the management of Rh- and ABO-mediated haemolytic disease of the newborn.

Haemolytic disease of the newborn (HDN) can be associated with significant morbidity. Prompt treatment with intensive phototherapy (PT) and exchange transfusions (ETs) can dramatically improve outcomes. ET is invasive and associated with risks. Intravenous immunoglobulin (IVIG) may be an alternative therapy to prevent use of ET. An international panel of experts was convened to develop evidence-based recommendations regarding the effectiveness and safety of IVIG to reduce the need for ETs, improve neurocognitive outcomes, reduce bilirubin level, reduce the frequency of red blood cell (RBC) transfusions and severity of anaemia, and/or reduce duration of hospitalization for neonates with Rh or ABO-mediated HDN. We used a systematic approach to search and review the literature and then develop recommendations from published data. These recommendations conclude that IVIG should not be routinely used to treat Rh or ABO antibody-mediated HDN. In situations where hyperbilirubinaemia is severe (and ET is imminent), or when ET is not readily available, the role of IVIG is unclear. High-quality studies are urgently needed to assess the optimal use of IVIG in patients with HDN.

Don't underestimate the power of culture.

Integrating a client's health care beliefs into the plan of care is the first step in providing culturally congruent care. Since caring is largely defined within a cultural context, knowing how clients wish to be cared for, and knowing about their culture, is paramount for the nursing profession. Transcultural nursing, a specialized area within nursing, embraces the power of culture. Transcultural nurses recognize and utilize the role of culture in the provision of culturally congruent care. By the year 2060, non-Hispanic whites are projected to comprise about half of the U.S. population (49.4%). In the year 2000, an estimated 12% of registered nurses were from an identified minority group. Therefore, it is not surprising that the culture of nursing in the United States continues to reflect the predominant values of the non-Hispanic white or Anglo-American culture. Ethnocentrism and cultural imposition must be avoided. Three major health belief systems (biomedical, naturalistic, and magico-religious) are presented with emphasis on their influential power with respect to health care practices. Underestimating the power of culture may be harmful to the health of the client.