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Antenatal phenobarbital for reducing neonatal jaundice after red cell isoimmunization

  • Review
  • Intervention

Authors


Abstract

Background

Neonates from isoimmunized pregnancies have increased morbidity from neonatal jaundice. The increased bilirubin from haemolysis often needs phototherapy, exchange transfusion or both after birth. Various trials in pregnant women who were not isoimmunized but had other risk factors for neonatal jaundice have shown a reduction in need for phototherapy and exchange transfusion by the use of antenatal phenobarbital. A recent retrospective case-controlled study showed reduction in the need for exchange transfusion for the neonates from isoimmunized pregnancies.

Objectives

To assess the effects of antenatal phenobarbital in red cell isoimmunized pregnancies in reducing the incidence of phototherapy and exchange transfusion for the neonate.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2009).

Selection criteria

Randomised and quasi-randomised controlled trials of pregnant women established to have red cell isoimmunization in the current pregnancy during their antenatal testing and given phenobarbital alone or in combination with other drugs before birth.

Data collection and analysis

All three review authors independently assessed study eligibility and quality.

Main results

No trials met the inclusion criteria for this review.

Authors' conclusions

The use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomised controlled trials.

摘要

背景

產前使用phenobarbital以減少紅血球同族免疫後的新生兒黃疸

同族免疫懷孕產下的新生兒,新生兒黃疸的發病率增加。溶血造成的膽紅素增加,通常需要在生產後進行光照療法、換血、或兩種方法都要用。非同族免疫、但是有其他新生兒黃疸風險因素之孕婦有各種試驗,顯示藉由產前使用phenobarbital,減少了光照療法和換血的需求。最近的回溯案例控制研究顯示,同族免疫孕婦的新生兒的換血需求減少。

目標

了評估產前使用phenobarbital於紅血球同族免疫孕婦,對其新生兒光照療法和換血的發生率的影響。

搜尋策略

我們搜尋Cochrane Pregnancy和Childbirth Group's Trials Register (2006年6月)。

選擇標準

產前檢查確認目前為紅血球同族免疫之孕婦,產前給予phenobarbital或併用其他藥物之隨機和準隨機控制試驗。

資料收集與分析

共有3位回顧作者獨立評估研究適用性與品質。

主要結論

沒有試驗符合本回顧的納入規範。

作者結論

未曾以隨機控制試驗評估產前使用phenobarbital以減少紅血球同族免疫孕婦之新生兒黃疸。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

並無適當證據支持產前使用phenobarbital以減少母親和胎兒血液不相容所造成的新生兒黃疸。母親和胎兒的血液在懷孕期間通常無正常交流,不過,偶爾可能從胎兒微量漏出胎兒血到母親,這在生產時比懷孕期間更常發生。當母親和胎兒的紅血球無法相容時、如果漏出的血量大時、嬰兒的紅血球細胞會刺激母親產生抗體,母親會變得敏感(同族免疫)。下次懷孕時,如果再度發生母親和胎兒的紅血球無法相容,胎兒的紅血球細胞會被摧毀,因為母親的抗體通過胎盤兒攻擊胎兒的血球。胎兒的肝臟無法因應紅血球破壞時的副產品(膽紅素),導致貧血和黃疸。因為phenobarbital可改善肝功能,產前給予母親可以降低嬰兒的膽紅素量,因而減少黃疸。這可減少嬰兒光照治療和換血的需求。此藥物有一些必須評估的輕微副作用。回顧作者發現,沒有同族免疫孕婦使用產前phenobarbital的隨機控制試驗報告。

Plain language summary

Antenatal phenobarbital for reducing neonatal jaundice after red cell isoimmunization

Inadequate evidence on antenatal use of phenobarbital for reducing jaundice in babies born to mothers whose blood is incompatible with the baby's blood.

The mothers and baby's bloods do not normally mix during pregnancy. However, occasionally there can be a small leak from the baby to the mother, and this happens more often during labour and birth than during pregnancy. When the mother's and the baby's red cells are incompatible, and if the leak is large enough, the baby's cells can stimulate the production of antibodies in the mother, and the mother becomes sensitized (isoimmunized). In a subsequent pregnancy, if again the mother's and the baby's red cells are incompatible, the baby's red cells can be destroyed as the mother's antibodies cross the placenta and attack the baby's blood cells. The baby's liver can have trouble coping with the byproduct (bilirubin) of the red cell destruction, resulting in anaemia and jaundice. Since phenobarbital improves the function of the liver, giving it to mothers just before birth may reduce the amount of bilirubin in the baby and thus reduce jaundice. This decreases the need for phototherapy and need for blood transfusion for the baby. This drug has some minor side effects which need to be assessed. The review of trials found no randomised controlled trials of antenatal phenobarbital in isoimmunized mothers.

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