Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn—a prospective randomized controlled trial

Abstract

Phototherapy is the standard treatment in moderately severe hemolytic disease of newborn (HDN), whereas exchange transfusion (ET) is the second line in progressive cases. Intravenous immunoglobin (IVIG) has been suggested to decrease the need for ET. We aimed at assessing the efficacy of early two-dose regimens of IVIG to avoid unnecessary ET in severe Rh HDN. The study included 90 full-term neonates with Rh incompatibility unmodified by antenatal treatment and not eligible for early ET and which were randomly assigned into one of three groups: group (I), treated by conventional method; groups IIa and IIb received IVIG once at 12 h postnatal age if PT was indicated, in a dose of 0.5 and 1 g/kg, respectively. Analysis revealed 11 neonates (22%) in the conventional group and 2 (5%) in the intervention group who administered low-dose IVIG at 12 h, while none in group IIb required exchange transfusion (p = 0.03). Mean bilirubin levels were significantly lower during the first 96 h in the intervention group compared to the conventional group (p < 0.0001). Shorter duration of phototherapy (52.8 ± 12.39 h) and hospital stay (3.25 ± 0.71 days) in the IVIG group compared to conventional group (84 ± 12.12 h and 4.72 ± 0.78 days, p < 0.0001, respectively) were observed. We conclude that IVIG administration at 12 h was effective in the treatment of severe Rh HDN; the low-dose IVIG (0.5 g/kg) was as effective as high dose (1 g/kg) in reducing the duration of phototherapy and hospital stay, but less effective in avoiding exchange transfusion.

Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real?

“…Alpay et al [12] showed that, high dose of IVIG (1 g/ kg) reduces hemolysis, serum bilirubin levels and risk of exchange transfusion in rhesus and ABO hemolytic disease on the other hand; Girish et al [13] demonstrated that, low dose of IVIG (0.5 g/kg) was also found to be as efficacious as high dose IVIG in reducing the duration of phototherapy. However low dose IVIG found to be less effective in avoiding exchange transfusion in rhesus hemolytic disease of the newborn [14]. Apart from these results, SmitsWintjen concluded that prophylactic treatment with IVIG in rhesus hemolytic disease did not reduce the need for exchange transfusion or adverse neonatal outcomes [15].…”

Intravenous immunoglobulin in isoimmune haemolytic disease of newborn: an updated systematic review and meta-analysis

“…Of the 12 included studies, 7 evaluated neonates with only Rh isoimmunisation,8 10 12 24 25 34 35 2 assessed neonates with only ABO isoimmunisation13 36 and 3 enrolled neonates with both Rh and ABO isoimmunisation 9 11 33. Most of the RCTs included a study population of term neonates.…”

Hemolytic Disease of the Fetus and Newborn: Modern Practice and Future Investigations

“…Although exchange transfusion is a critical therapy for prevention of kernicterus in neonates with rapidly rising bilirubin, it does have complications 28 . IVIg has been shown to reduce the need for exchange transfusion in some studies 29,30 . However, it does not affect anemia significantly, and top off transfusions may still be needed…”