Early Administration of Intravenous Immunoglobulin in the Management of Isoimmune Hemolytic Disease in Neonates

Vijay Kulkarni, Goutam Kabbin, Pranab Jonnala

Abstract

Background and Aim: Neonatal jaundice, that occurs secondary to isoimmune hemolytic disease, results from hemolysis of RBCs due to transplacental passage of maternal antibodies. There is significant evidence that intravenous immunoglobulin (IVIG) administration decreases hemolysis and thus reduces serum bilirubin level, which in turn reduces the need for exchange transfusion. 

This study was conducted to assess the role of IVIG in reducing the need for exchange transfusion in neonates with isoimmune hemolytic disease.

Materials and Methods: This was a prospective observational study conducted in neonates with Rh/ABO incompatibility. The neonates were initially started on conventional phototherapy, and if the rise in bilirubin was > 0.5 g/kg/h, IVIG was administered initially at a dose of 0.5 g/kg through IV infusion for over 4 hours at a rate of 0.01 mg/kg/min. Serum bilirubin level was estimated after 6 hours and then after 24 hours. In 6 of the neonates, a reduction in bilirubin level was not achieved with a single dose and thus a second dose of IVIG was administered.

Results: No statistically significant relationship was observed between the incidence of jaundice and age, sex, and birth weight of neonates. A significant reduction in the mean duration of hospital stay and phototherapy was found. Use of IVIG is safe as none of the neonates showed any complications.

Conclusion: Routine use of IVIG therapy along with phototherapy is recommended for the treatment of isoimmune hemolytic disease in neonates to decrease the need for exchange transfusion and reduce the duration of phototherapy and hospital stay.

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