High‐dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice

Alpay, Faruk; Sarıcı, S. Ümit; Okutan, Vedat; Erdem, Galip; Özcan, Okan; Gökçay, Erdal

doi:10.1111/j.1651-2227.1999.tb01085.x

Cited by 54 publications

(15 citation statements)

References 22 publications

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“…The use of IVIG was first shown to be effective for treating blood group incompatibility in the 1990's ( 11 ). Since then, it has been used to treat HDN to avoid exchange transfusion, but there is still no consensus on its use.…”

Section: Discussionmentioning

confidence: 99%

“…The need for exchange transfusion treatment after IVIG use has varied among studies. Many factors, including age upon admission to the hospital, duration and strength of phototherapy, and dose and time of administration of IVIG may influence the response to IVIG ( 11 , 17 , 21 ). Hammerman et al reported that infants who did not respond sufficiently to IVIG therapy have higher carboxy-hemoglobin levels, which means that their hemolysis was more severe ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

et al. 2022

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IntroductionIntravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion.Materials and MethodsThis study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2–3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared.ResultsDuring the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups (p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group (p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group (p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group (p < 0.001 and p = 0.01, respectively).ConclusionIn this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

et al. 2022

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“…Usage of IVIg has been found to decrease the need of ET in both Rh and ABO isoimmune HDN. [1][2][3][4] High dose of IVIg (0.5-1 g/kg) is recommended by the American Academy of Pediatrics (AAP) in 2004 as an additional treatment of isoimmune HDN. 5 Since then, IVIg has been successfully utilized in isoimmune HDN.…”

Section: Introductionmentioning

confidence: 99%

Role of IVIg in Severe Neonatal Jaundice due to Isoimmunization A Retrospective Cohort Study

Sharma

Bhatti

Bakshi

2023

Journal of Neonatology

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Aim To see the efficacy of intravenous immunoglobulin (IVIg) in reducing the need for exchange transfusion (ET) in neonates with isoimmune hemolytic disease with serum bilirubin at or above exchange level. Methods Retrospective cohort study conducted in neonatal intensive care unit of a tertiary care center from March 2015 to February 2020 included neonates with gestational age ≥35 weeks with positive Direct Coombs Test with serum bilirubin at or above exchange level according to American Academy of Pediatrics charts with no bilirubin encephalopathy at presentation. Study subjects were followed till discharge. Results ET was prevented in 8/41 (19.5%) cases who received IVIg initially vs. 2/51 cases (3.92%) who didn’t ( P = .02, relative risk: 1.98 with 95% confidence interval [1.32-2.98] with number needed to treat: 2.51). Total duration of phototherapy was significantly lesser in those receiving IVIg ( P < .0001). Conclusion Targeted use of IVIg in isoimmune hemolytic disease of newborn with serum bilirubin rising despite intensive phototherapy or within 2 to 3 mg/dL of the exchange level is more likely to benefit than harm and remain prudent.

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“…The administration of intravenous immunoglobulin (IVIG) is an adjunctive treatment by blocking of the reticuloendothelial Fc receptor sites and thereby preventing the extravascular destruction of neonatal red blood cells (RBCs) sensitized by maternal antibodies [7, 8]. It was shown to decrease the need for blood exchange transfusion [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, an association with necrotizing enterocolitis has also been described [13]. However, IVIG has been deemed safe, and is generally well tolerated with a limited side effect profile [7-10, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Immunoglobulins as Adjunct Treatment to Phototherapy in Isoimmune Hemolytic Disease of the Newborn: A Retrospective Case-Control Study

et al. 2019

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BackgroundIsoimmune hemolytic disease is a major cause of neonatal severe indirect hyperbilirubinemia that requires phototherapy or exchange transfusion which is an invasive procedure to avoid brain injury. Administration of intravenous immunoglobulin (IVIG) is used as an adjunct treatment to phototherapy in order to decrease the rate of exchange transfusion.MethodsThis retrospective case-control study aimed to describe the safety and efficacy of IVIG therapy in newborns with isoimmune hemolytic disease and to compare their clinical outcomes to those of a control group who were treated only with phototherapy. Criteria for IVIG treatment were variable; when phototherapy threshold was reached or when exchange transfusion level was approached, using either indication is based on the attending discretion.ResultsNinety-four infants were included in the IVIG group, compared to 108 infants in the control group. Most of the included infants were term infants and most common cause was ABO incompatibility. There were no side effects documented in all the included infants. The IVIG group had more severe hemolysis with average highest bilirubin of 14.6 ± 3.7 mg/dL in the IVIG group versus 12.6 ± 3 in the control group (P = 0.0001). Complication of hemolysis was seen more in the IVIG group with higher rate of rebound hyperbilirubinemia, blood transfusion and exchange transfusion.ConclusionsIVIG use as an adjunct treatment to phototherapy in isoimmune hemolytic disease of the newborns is safe. The favorable results of the phototherapy only group were supportive of using selective criteria for administration of IVIG in neonates with isoimmune hemolytic disease.

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High‐dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice

Cited by 54 publications

References 22 publications

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion

Role of IVIg in Severe Neonatal Jaundice due to Isoimmunization A Retrospective Cohort Study

Intravenous Immunoglobulins as Adjunct Treatment to Phototherapy in Isoimmune Hemolytic Disease of the Newborn: A Retrospective Case-Control Study

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