Necrotizing Enterocolitis in a Term Neonate Following Intravenous Immunoglobulin Therapy

Abstract

A term baby with severe BO isoimmunization was treated with intravenous immunoglobulin. Shortly after the completion of the infusion, the baby developed clinical and radiological signs of necrotizing enterocolitis, with intestinal perforation and massive hemorrhagic ascites, resulting in the death of the baby.

Fetal and neonatal alloimmune thrombocytopenia: recommendations for evidence‐based practice, an international approach

“…The platelet count increase in the neonate (if it occurs) may take 24–72 h following IVIG infusion when given alone. Given limited data supporting its efficacy as an adjunct agent, as well as potential side effects from IVIG (including haemolysis in non‐group O neonates and neutropenia) (Majer & Green, ; Veys et al , ; Singh‐Grewal et al , ; Khan et al , ; Krishnan & Pathare, ; Luban et al , ; Akman et al , ), IVIG was not considered in addition to platelet transfusion.…”

Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11‐year study

“…However, several studies have reported an association between IVIG administration and the development of NEC in neonates. Similar to septic infants, IVIG administration for NEC occurred in the first half of the study, before other studies reporting NEC as an adverse reaction to IVIG were published . Earlier publication of those findings may have influenced practice.…”

“…If clinicians do decide to order IVIG, whether within or outside of clinical guidelines, then the benefits and risks must be considered and discussed with the patient's family. IVIG is a blood product, and adverse events, including NEC and severe hemolysis, have been reported after its use. IVIG also potentially may cause hemolysis in nongroup O neonates, because IVIG contains anti‐A and anti‐B.…”

“…Intravenous immunoglobulin (IVIG) is a fractionated blood product used to treat a wide range of diseases in neonatal intensive care units (NICUs). Its use has been associated with significant morbidity, including severe hemolysis and necrotizing enterocolitis (NEC) . Although experts recommend using this product to prevent severe cases of hemolytic disease of the newborn (HDN) and neonatal alloimmune thrombocytopenia, its value in other scenarios, such as sepsis, appears to be limited .…”

Necrotising Enterocolitis - epidemiology and imaging

“…82,237 Our data do not reveal whether the association of NEC with isoimmunisation is linked with the condition itself or with its treatment. Case reports and retrospective studies have suggested that treatment of hemolytic anemia with intravenous immunoglobulins may precipitate NEC, 156,158 which is also counted among complications of exchange transfusion 106,238 but Roig and Burchfield reported two cases of NEC in infants with isoimmunisation before exchange transfusion. 239 Isoimmunisation is likely to predispose to general vulnerability and can be speculated to contribute to imbalance of the developing immune system, which might precipitate NEC.…”