High dose intravenous immunoglobulin in Rh and ABO hemolytic disease of Egyptian neonates

Abstract

Background: Despite advances made in the use of phototherapy, and in order to avoid sequelae of kernicterus, the treatment of hyperbilirubinemia may require one or several exchange transfusions, an invasive therapy which is not without risk. Intravenous immune globulin treatment in isoimmune hyperbilirubinemia has been shown to be effective, but the response to treatment is variable. Objective: To evaluate effectiveness of high dose Intravenous immune globulin (HD-IVIG) in reducing the need for exchange transfusion, duration of phototherapy and/or hospitalization in neonates with isoimmune hemolytic disease due to Rh or ABO incompatibility. Methods: The study included 116 direct Coombs' test positive neonates delivered at Gynecology and Obstetrics Hospital of Ain Shams University, Cairo, Egypt. They were randomly assigned to receive phototherapy with HD-IVIG in a single dose of 1 gm/kg (60 neonates, intervention group) or phototherapy (56 neonates, control group). Results: Nine neonates in the intervention group (15%) and 23 (41%) in the control group required single exchange transfusion (p< 0.001). Multiple exchange transfusion was indicated in 15 neonates (26.8%) in the control group versus none in the intervention group (p< 0.001). Compared with control group, neonates in the intervention group had shorter mean duration of intensive phototherapy (9.97 versus 35.5 hours, p<0.001) and hospital stay (27.9 versus 103.5 hours, p< 0.001). No adverse effects of HD-IVIG administration were noted. Conclusion: HD-IVIG effectively reduced the requirement for exchange transfusion and duration of phototherapy and hospitalization in isoimmune hemolytic disease of the newborn.

Keywords: Hemolytic disease of newborn; hyperbilirubinemia; exchange transfusion; high dose intravenous immunoglobulin.