Intravenous immunoglobulin in hemolytic disease of the newborn: A moving target in time

Patient experience and burden of haemolytic disease of the foetus and newborn: a systematic review

BACKGROUND

Haemolytic disease of the foetus and newborn (HDFN) is an immune disorder driven by maternal alloimmunisation against foetal/newborn red blood cell antigens. HDFN can cause significant morbidity and mortality, with symptoms in the foetus ranging from mild anaemia to hydrops fetalis. While in newborns, HDFN can lead to severe forms of neonatal hyperbilirubinaemia and kernicterus. This systematic review (SR) aimed to identify and summarise real-world evidence (RWE) related to the patient burden/experience and economic burden of HDFN.

METHODS

Electronic database searches supplemented by handsearching of grey literature, were conducted to identify studies that reported the clinical patient burden/experience, and economic burden of HDFN in Europe, the Middle East, and Africa (EMEA). Data from eligible studies were summarised in a narrative synthesis due to heterogeneity between studies.

RESULTS

A total of 26 relevant publications were identified for inclusion in the SR, consisting of one study that directly measured Health Related Quality of Life, 9 studies reporting on proxy outcomes for patient burden and 18 studies reporting on economic burden (this includes two double-counted studies reporting more than one outcome type). Neurodevelopment, academic development, behaviour and personality were assessed as proxy outcomes for patient burden given the limited identification of patient-reported outcome data. These studies suggested potential neurodevelopmental impairments in children with HDFN. Despite these indirect insights into patient burden, identified data were limited and results should be interpreted with consideration of the inherent heterogeneity in design and endpoints assessed across RWE studies. Economic burden data were primarily limited to healthcare resource use outcomes, with limited reported data on healthcare costs, it is difficult to draw notable conclusions on the true economic burden of HDFN.

CONCLUSIONS

The current SR provides a clear summary of the available evidence for the patient experience and economic burden of HDFN. While the limited evidence indicates that HDFN does confer a significant burden on patients, the review identifies the need for further well-powered and representative observational studies using well-defined outcome measures to aid a greater understanding of the burden and experience of HDFN.

TRIAL REGISTRATION

The protocol for this systematic review was registered in PROSPERO CRD42022328444.

Metabolomics-based study on the significance of differential metabolite binding IgG isoforms in Hemolytic disease of newborn

BACKGROUND

Hemolytic disease of the newborn (HDN) is a common condition that can have a severe impact on the health of newborns due to the hemolytic reactions it triggers. Although numerous studies have focused on understanding the pathogenesis of HDN, there are still many unanswered questions.

METHODS

In this retrospective study, serum samples were collected from 15 healthy newborns and 8 infants diagnosed with hemolytic disease. The relationship between different metabolites and various IgG subtypes in Healthy, HDN and BLI groups was studied by biochemical technique and enzyme-linked immunosorbent assay (ELISA). Metabolomics analysis was conducted to identify the differential metabolites associated with HDN. Subsequently, Pearson's correlation analysis was used to determine the relation of these differential metabolites with IgG isoforms. The relationship between the metabolites and IgG subtypes was observed after treatment.

RESULTS

The study results revealed that infants with hemolytic disease exhibited abnormal elevations in TBA, IgG1, IgG2a, IgG2b, IgG3, and IgG4 levels when compared to healthy newborns. Additionally, differences in metabolite contents were also observed. N, N-DIMETHYLARGININE showed negative correlations with TBA, IgG1, IgG2a, IgG2b, IgG3, and IgG4, while 2-HYDROXYBUTYRATE, AMINOISOBUTANOATE, Inosine, and ALLYL ISOTHIOCYANATE exhibited positive correlations with TBA, IgG1, IgG2a, IgG2b, IgG3, and IgG4. Through metabolomics-based research, we have discovered associations between differential metabolites and different IgG isoforms during the onset of HDN.

CONCLUSION

These findings suggest that changes in metabolite and IgG isoform levels are linked to HDN. Understanding the involvement of IgG isoforms and metabolites can provide valuable guidance for the diagnosis and treatment of HDN.

Novel noninvasive indices for the assessment of liver fibrosis in primary biliary cholangitis

The present study aimed to investigate the accuracy of new noninvasive markers in predicting liver fibrosis among individuals with primary biliary cholangitis (PBC). This retrospective analysis included subjects with PBC who had liver biopsies. Scheuer's classification was used to determine the fibrosis stage. The bilirubin to albumin (Alb) ratio (BAR), fibrosis index based on the four factors (FIB-4), γ-glutamyl transpeptidase to platelet (PLT) ratio (GPR), red cell distribution width to PLT ratio (RPR), aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), AST to PLT ratio index (APRI) and total bilirubin to PLT ratio (TPR) were calculated based on the laboratory parameters. A novel index called BARP was conceived as BAR x RPR. A total of 78 individuals with PBC were included in the study, 84.6% of whom had significant fibrosis, 30.8% had advanced fibrosis and 15.4% had cirrhosis. In the multivariate analysis, Alb was determined to be an independent predictor of advanced fibrosis (odds ratio=0.823, P=0.034). The area under the receiver operating characteristic curves (AUROCs) of the BAR, GPR, TPR and BARP were statistically significant in predicting severe fibrosis (P<0.05) and were 0.747, 0.684, 0.693 and 0.696, respectively. In assessing advanced fibrosis, the AUROCs for the AAR, APRI, BAR, FIB-4, RPR, TPR and BARP were 0.726, 0.650, 0.742, 0.716, 0.670, 0.735 and 0.750, respectively. The AUROCs for the APRI, BAR, FIB-4, RPR, TPR and BARP for cirrhosis prediction were 0.776, 0.753, 0.821, 0.819, 0.808 and 0.832, respectively. By comparing the AUROCs, it was demonstrated that the diagnostic capabilities of the BARP (P=0.021) and TPR (P=0.044) were superior to those of the APRI in predicting advanced fibrosis. In conclusion, the BAR, BARP and TPR were of predictive value for the grade of liver fibrosis in PBC and Alb had a diagnostic value in identifying early fibrosis. The aforementioned noninvasive indices may be used for predicting histologic stages of PBC.