Treatment of Neonatal Immune Thrombocytopenia with
High Dose Intravenous γ-Globulin

Linder, Nehama; Shapiro, Seth; Moser, A M; Roitman, Janna; Engelhard, Dan

doi:10.1159/000480899

Cited by 12 publications

(5 citation statements)

References 6 publications

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“…8 High-dose IVIG has been repeatedly reported to be effective in cases of NAIT; however, the evidence derives from small case reports without a control group. [24][25][26] The results of our survey differ from those of another survey that was conducted in the United Kingdom in 1996. 27 When asked about their preferred initial treatment of an infant with a provisional diagnosis of fetomaternal alloimmune thrombocytopenia and unknown specificity of the maternal antibodies, only 2 of 93 hematology departments in the United Kingdom selected randomdonor PLTs.…”

Section: Discussioncontrasting

confidence: 95%

“…The usual recommended dose of IVIG is 2 g per kg administered either as 0.4 g per kg daily for 5 days or as 1 g per kg on 2consecutive days, the latter regimen being preferentially selected in our survey 8 . High‐dose IVIG has been repeatedly reported to be effective in cases of NAIT; however, the evidence derives from small case reports without a control group 24‐26 …”

Section: Discussionmentioning

confidence: 99%

“…IVIG also appears to increase PLT counts in the majority of cases, but the response is usually delayed for 1 to 3 days. [24][25][26] It could therefore be considered as a backup strategy in the management of cases without evidence of bleeding and/or second-line therapy when PLT counts fail to improve with antigen-negative compatible or randomdonor PLT transfusions. Our survey did not incorporate questions on the use of combined strategies such as IVIG and PLTs in the management of specific clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and survey of the management of unexpected neonatal alloimmune thrombocytopenia

Bassler

Greinacher²,

Okascharoen³

et al. 2007

Transfusion

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BACKGROUND: Unexpected neonatal alloimmune thrombocytopenia (NAIT) may have devastating consequences and its management is challenging. To design future trials, evidence from the literature and existing best practice need review. STUDY DESIGN AND METHODS: This study was a cross‐sectional survey of neonatal units in Germany and Canada to determine management strategies of NAIT and a systematic search for randomized controlled trials (RCTs). RESULTS: Management of NAIT differs substantially between countries with regard to platelet (PLT) thresholds for screening, initiation of therapy, and treatment. Seventy‐seven percent of Canadian physicians versus 68 percent of German physicians screen preterm and term infants, at a PLT threshold of 30 × 109 to 100 × 109 per L. In preterm infants, 60 percent of Canadian neonatologists commence treatment at a PLT count of between 30 × 109 and 50 × 109 per L. In Germany 32 percent of the physicians start treatment at this level and 25 percent use a threshold of between 10 × 109 and 20 × 109 per L. In term infants, 6 percent of the Canadian physicians and 16 percent of the German physicians use even lower treatment triggers of between 5 × 109 and 10 × 109 per L. In the presence of bleeding, 61 percent of German physicians await the arrival of antigen‐negative PLTs, while 64 percent of Canadian neonatologists prefer intravenous immunoglobulin or random‐donor PLTs (81%). Maternal PLTs are utilized by 31 percent of physicians in both countries. No RCTs were identified. CONCLUSION: In the absence of RCTs, management of unexpected NAIT differs between countries. Clinicians and transfusion services may use the results of our study to develop collaborative protocols, redefine preferred hospitalwide strategies, and design future controlled trials.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A systematic review and survey of the management of unexpected neonatal alloimmune thrombocytopenia

Bassler

Greinacher²,

Okascharoen³

et al. 2007

Transfusion

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“…It is recommended for NAIT if other treatments fail (grade C recommendation, level III evidence) & is effective in 75% of cases. High-dose IVIG (400 mg/kg day over 5 days) has been shown to be effective in infants with NAIT in few case reports [49,50,51].…”

Section: Abo Hemolytic Diseasementioning

confidence: 99%

Intravenous Immunoglobulin in Neonates: Current Perspective

Chandran

Gedam²

2016

Int J Pediatr Res

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IVIG is being used off-label in newborns for sepsis prophylaxis, treatment of neonatal alloimmune diseases such as HDN & NAIT.Though earlier studies supported IVIG prophylaxis in neonatal sepsis prevention, latest INIS Trial showed that IVIG is not recommended to prevent neonatal sepsis. Use in treatment of sepsis remains controversial. Cochrane systematic review suggested a beneficial effect on mortality. Significant reduction in mortality occurred with addition of IgM-enriched IVIG. Nowadays IVIG is being increasingly used in Hemolytic Disorders mainly blood group incompatibility. It has been found to reduce multiple exchange transfusions, length of hospital stay & duration of phototherapy. Possible side effects include fever, allergic reactions, hypoglycaemia, hypotension, haemolysis, fluid overload & anaphylaxis. Pending FDA approval, prompt & judicious administration of IVIG with close monitoring for any adverse events is mandatory.

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“…49,50 High-dose IVIG (400 mg/kg day over 5 days) has been shown to be effective in infants with NAIT in a small number of case reports. [51][52][53] Ballin et al 54 reported success with a dose of 1 g/kg/d for 2 consecutive days, and Linder et al 55 reported a beneficial effect of a single dose of IVIG (1 g/kg/d) in four infants with a fifth infant requiring a second dose. These authors reported no adverse effects.…”

Section: Postnatal Managementmentioning

confidence: 99%

Fetal and Neonatal Alloimmune Thrombocytopenia: Harvesting the Evidence to Develop a Clinical Approach to Management

Symington¹,

Paes²

2010

Amer J Perinatol

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Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in an otherwise healthy newborn. The most serious complication is intracranial hemorrhage, which can occur either in the fetus or the newborn. Despite the known serious sequelae, both antenatal management and neonatal treatment modalities are plagued by the lack of gold standard evidence to appropriately direct therapy. Maternal, risk-based therapeutic approaches range from invasive protocols to relatively benign noninvasive strategies to avoid serious procedural complications. Intravenous immunoglobulin (IVIG) with or without steroids and fetal blood sampling constitute the mainstay of antenatal management. Neonatal interventions principally focus on the use of antigennegative compatible or random donor platelets and IVIG. While awaiting the results of controlled trials, each institution must develop a standardized, collaborative, multidisciplinary approach to the screening, diagnostic evaluation, and management of unexpected and anticipated NAIT based on experience, product availability, and emerging scientific data.

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Treatment of Neonatal Immune Thrombocytopenia with High Dose Intravenous γ-Globulin

Cited by 12 publications

References 6 publications

A systematic review and survey of the management of unexpected neonatal alloimmune thrombocytopenia

A systematic review and survey of the management of unexpected neonatal alloimmune thrombocytopenia

Intravenous Immunoglobulin in Neonates: Current Perspective

Fetal and Neonatal Alloimmune Thrombocytopenia: Harvesting the Evidence to Develop a Clinical Approach to Management

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