Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Newborn infants with alloimmune haemolytic disease
Intervention: Intravenous immunoglobulin (IVIG)
Comparison: Placebo or no treatment
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Use of exchange transfusion | Favours intervention | Very Low |
Exchange transfusions per infant | Favours intervention | Very low |
Use of top‐up transfusion (in first week) | No statistically significant difference | Low |
Use of top‐up transfusion (after first week) | No statistically significant difference | Very low |
Top‐up transfusions per infant (in first week and after first week) | No statistically significant difference | GRADE assessment not performed for this outcome |
Maximum total serum bilirubin | Favours intervention | Very low |
Duration of phototherapy | Favours intervention | GRADE assessment not performed for this outcome |
Longer‐term neurological outcomes (1 to > 2 years) | See note ᵃ | GRADE assessment not performed for this outcome |
Adverse effects | See note ᵇ | GRADE assessment not performed for this outcome |
Neonatal mortality | - | None of the studies identified by the review assessed this outcome |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) stated that the methods of only two of the nine included studies were robust enough to guide routine clinical practice, and that the quality of the evidence as assessed by GRADE was all low to very low. Therefore, they concluded that there is insufficient evidence to support the routine use of IVIG in infants with alloimmune haemolytic disease. ᵃ Results reported narratively; two RCTs (204 infants) reported no cases of kernicterus, deafness or cerebral palsy, while a third RCT (80 infants) reported that neurodevelopmental outcome at aged ≥ 2 years was the same in those treated with IVIG and those treated with placebo. ᵇ Results reported narratively; no adverse effects were reported in the IVIG group (9 RCTs; 658 infants). Sixteen infants across 6 RCTs were reported to have hypoglycaemia, hypocalcaemia, sepsis (with or without brain abscess), and inspissated bile syndrome, due to exchange transfusion.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the benefits and harms of immunoglobulin for neonates with alloimmune hemolytic disease/jaundice?
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