What is the role of IVIG in the treatment of hemolytic disease of the newborn (HDN)?

Updated: Dec 28, 2017
  • Author: Sameer Wagle, MBBS, MD; Chief Editor: Muhammad Aslam, MD  more...
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Answer

IVIG has been shown to reduce the need for exchange transfusion in hemolytic disease of the newborn due to Rh or ABO incompatibility. The number needed to treat to prevent one exchange transfusion was noted to be 2.7 and was estimated to be 10, if all the infants with strongly positive direct Coombs test were to receive the medication. [49, 50]  In addition, it also reduced the duration of hospital stay and phototherapy. [51]  Although it was very effective as a single dose, multiple doses were more effective in stopping the ongoing hemolysis and reducing the incidence of late anemia.

A randomized, controlled trial by Smits-Wintjens et al, however, failed to show the benefit of prophylactic single-dose IVIG at 0.75 g/kg within 4 hours of life in severely sensitized neonates with prior IUT due to Rh alloimmunization. [52]  Although IVIG has been proven to be safe, a retrospective review reported almost 30-times increased risk of necrotizing enterocolitis (NEC) in late preterm and term infants. [53]

Tin-mesoporphyrin in a dose of 4.5 mg/kg (6 µmole/kg) was used in an infant with persistent hemolysis due to Rh alloimmunization to prevent need for further phototherapy, without any adverse effects. [54]


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