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Our aim was to assess the effectiveness of neonatal treatment of Rh hemolytic disease with high-dose intravenous immunoglobulin (HDIVIG), in reducing neonatal hemolysis. A total of 40 neonates born to isoimmunized Rh negative women were studied. The population was randomized into 2 groups: Group 1 received IVIG 800 mg/kg/day for 3 days, plus phototherapy; and Group 2 received only phototherapy. No significant difference was observed between the groups in the severity of either the antenatal and neonatal disease, mode of delivery, mean birthweight, gestational age at delivery, proportion of preterm deliveries, 1 minute Apgar Score, days of phototherapy, and presence of neonatal cholestasis. Group 1 babies showed a significantly decreased duration of hospitalization, less hemolysis, and a less marked increase in bilirubin levels on the first day of life than Group 2 newborns. Therefore, Group 1 neonates received less treatment with transfusions (exchange-transfusions and/or simple blood treatment with transfusions) than those in Group 2. Our data suggest that the frequency of transfusional therapy can be reduced by combining conventional phototherapy with HDIVIG. Further studies are needed to determine the optimum timing and dosages of neonatal HDIVIG treatment.

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A gravida 4, para 3, group 1 Rh (D) positive woman with a group O Rh (D) positive husband and without a history of obstetric or clinical pathology is presented. Fetal ascites and pericardial effusion were diagnosed through ultrasound at 22 weeks of amenorrhea. These findings were reconfirmed ultrasonically at 25 weeks, so the patient was referred to our hospital to corroborate diagnosis. Indirect Coombs test was negative and no irregular antibodies were detected. Non-immunological hydrops was then suspected and the following studies were proposed: fetal blood sampling by cordocentesis for genetic diagnosis, assessment of fetal hematologic and immunologic condition and TORCH; intrauterine intravascular treatment would then be indicated if required. Fetal blood sampling showed: fetal blood group A Rh (D) positive, a direct negative Coombs test, hematocrit 27%, hemoglobin 8.7 g%, total protein level 3 g%, a normal Karyotype and negative TORCH. Because of the low albumin levels, 4 albumin transfusions were administered (3 intravascular and 1 intracardiac). Adrenalin was infused into the fetus at each procedure. After the first 2 transfusions, total remission of hydrops was observed. A cesarean section was performed at 34 weeks and a live male, blood group A Rh (D) positive infant without ascites and weighing 1900 g was born. Coombs test was negative. No hepato or splenomegalla was observed. However, the neonate presented with respiratory distress syndrome, requiring mechanical ventilation for 3 days. Neonatal evolution was satisfactory (negative TORCH, normal ECG, normal abdominal echographic studies, negative blood culture). The advantages of intrauterine treatment are stressed and the possible etiology on nonimmunological hydrops is discussed.