IVIg in the newborn period should be cautiously employed and always administered under strict medical control.

Intravenous immune globulin (IVIG) is manufactured from plasma isolated from healthy blood donors and includes mostly immunoglobulin G (IgG). IVIG is approved by the United States Food and Drug Administration (FDA) for use in a variety of diseases in adults and children, although there are no FDA-approved uses of IVIG in newborns. Off-label use of IVIG in newborns includes prophylaxis against infections in low-birthweight infants and treatment of neonatal alloimmune diseases such as hemolytic disease of the newborn (HDN) and neonatal alloimmune thrombocytopenia (NAIT). More recently, IVIG has been used in parvovirus B19 infection, hemochromatosis, and neonatal Kawasaki disease. The mechanism of action of IVIG includes antibody-specific immunity as well as mechanisms triggered via IgG binding to fragment crystallizable (Fc) receptors on phagocytes, natural killer (NK) cells, and reticuloendothelial cells located throughout the body. Adverse effects of IVIG in adults and children are well recognized and include anaphylaxis, thromboembolism, renal failure, and aseptic meningitis. The adverse effects of IVIG in the newborn are less well described but include severe diseases such as necrotizing enterocolitis (NEC). Hence, although IVIG may be indicated as an adjunct for the prevention and treatment of infectious and certain alloimmune-mediated diseases in infants, it should be used with caution in the newborn period.

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