Immune globulin
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Lack of efficacy: case report A study of three neonates diagnosed with neonatal adrenal haemorrhage (NAH) described a male neonate [exact age not stated], who exhibited lack of efficacy during treatment with immune globulin. The neonate was born at 373/7 weeks of postmenstrual age, by spontaneous vaginal delivery. The mother had horseshoe kidney and no family history of inherited disorders. The perinatal period was characterized by birth asphyxia (Apgar score of 4 and 7 at 1 and 5 minutes of life, respectively). At birth, he showed pallor, hypotonia, absence of spontaneous crying and respiratory distress. Therefore, he was given resuscitation through mechanical ventilation. On examination, he exhibited traumatic cyanosis of the face, bruising on the right forearm with good motility of the limb and voluminous bilateral hydrocele. At birth, he was given vitamin K. No remarkable neurological impairment was noted in the first few hours of life. During the first day of life, ecchymosis appeared on the right scrotum. Additionally, he developed jaundice in the first 48 hours of life. Direct Coombs’ test was positive for AB0 incompatibility. He received phototherapy cycles for 24 hours; however, further increase in bilirubinaemia (hyperbilirubinaemia) and signs of haemolysis were noted. Therefore, two doses of IV immune globulin [immunoglobulin] 1 g/kg/dose, were given, which were not useful (lack of efficacy). Therefore, phenobarbital therapy was given to improve bile flow. On 10th day of life, phototherapy was restarted, with gradual improvement. Abdominal ultrasound performed at 7 days of life showed finding consistent with NAH with right adrenal gland involvement. Eventually, haemorrhagic lesions decreased and resolved completely by the age of 3 months. Tognato E, et al. Neonatal Adrenal Hemorrhage: A Case Series. American Journal of Perinatology 37 (Suppl. 2): S57-S60, No. 17, Sep 2020. Available from: URL: http:// doi.org/10.1055/s-0040-1713407 803516134
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Reactions 21 Nov 2020 No. 1831
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