Intravenous Immune Globulin Uses in the Fetus and Neonate: A Review

Abstract

Intravenous immune globulin (IVIG) is made after processing plasma from healthy donors. It is composed mainly of pooled immunoglobulin and has clinical evidence-based applications in adult and pediatric populations. Recently, several clinical applications have been proposed for managing conditions in the neonatal population, such as hemolytic disease of the newborn, treatment, and prophylaxis for sepsis in high-risk neonates, enterovirus parvovirus and COVID-19 related neonatal infections, fetal and neonatal immune-induced thrombocytopenia, neonatal hemochromatosis, neonatal Kawasaki disease, and some types of immunodeficiency. The dosing, mechanism of action, effectiveness, side effects, and adverse reactions of IVIG have been relatively well studied in adults but are not well described in the neonatal population. This review aims to provide the most recent evidence and consensus guidelines about the use of IVIG in the fetus and neonate.

Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series

“…All patients in our case series received immunomodulatory therapies (intravenous immunoglobulin-IVIG and steroids), anti-platelet agents (aspirin), and anticoagulants (unfractionated heparin or LMWH). Further studies are required to evaluate the benefits and risks of these therapies in MIS-N [23,25]. While some cases, especially those with cardiac conduction abnormalities responded well to IVIG and steroid therapy, we need randomized trials to evaluate efficacy of these therapies in MIS-C. Overuse of these agents should be avoided.…”

“…Infants who meet criteria for Kawasaki disease should also receive IVIG. [ 23 ] Caution should be exercised during IVIG among neonates due to the potential risk of necrotizing enterocolitis. [ 24 ]…”

Presumptive Neonatal Multisystem Inflammatory Syndrome in Children Associated with Coronavirus Disease 2019

“…IVIG administration in neonates is considered to be safe; however, rare adverse reactions have been reported. 10 It is therefore imperative that IVIG is administered slowly, under continuous cardiorespiratory monitoring, with careful monitoring of fluid status, and immediate treatment for anaphylaxis should be available. The mechanism of action of IVIG is not completely understood; immunomodulatory and anti-inflammatory effects have been proposed.…”

“…The mechanism of action of IVIG is not completely understood; immunomodulatory and anti-inflammatory effects have been proposed. 10 The trigger for initiating a dysregulated immune response to COVID-19 infection manifesting as MIS-C remains unknown. [1][2][3]8,9 Rostad et al have reported that patients with MIS-C had high titers of SARS-COV-2 receptor binding domain IgG antibodies compared with other hospitalized patients with and without COVID-19 infection, these titers correlated with markers of inflammation and length of stay.…”

IgG regulation through FcRn blocking: A novel mechanism for the treatment of myasthenia gravis

“…This is particularly relevant during pregnancy, as neonates do not acquire IgA and IgM through placental transfer, and IgA is the primary isotype that is acquired through mothers' milk. A possible solution could be treatment of the neonates with IVIg [88,89].…”