What is the Intravenous Immunoglobulin (IVIG) dose for neonatal jaundice?

From the Guidelines

The recommended dose of intravenous immunoglobulin (IVIG) for neonatal jaundice is 0.5-1 g/kg over 2 hours, which may be repeated in 12 hours if necessary. This dose is specifically indicated for infants with isoimmune hemolytic disease and total serum bilirubin (TSB) levels rising in spite of intensive phototherapy or within 2–3 mg/dL of exchange level 1. When administering IVIG, it's crucial to monitor the infant's vital signs and hydration status, as dehydration can exacerbate hyperbilirubinemia. Key considerations include:

• Monitoring for signs of dehydration, such as weight loss > 12% from birth, and recommending formula or expressed breast milk if oral intake is questionable 1
• Administering intravenous fluids if there's evidence of dehydration or concern about oral intake
• Using IVIG as an adjunct to intensive phototherapy, rather than as a replacement, to help reduce the destruction of antibody-coated red blood cells and decrease the rate of hemolysis. The mechanism of action of IVIG involves blocking Fc receptors on reticuloendothelial cells, which helps prevent further increases in bilirubin levels and may reduce the need for exchange transfusion 1.

From the Research

IVIG Dose in Neonatal Jaundice

• The optimal dose of IVIG in neonatal jaundice is not explicitly stated in the provided studies, but the doses used in the studies were:
  • 0.5 g/kg over 4 hours, every 12 hours for 3 doses 2
  • 500 mg/kg over 2-4 hours 3
• The studies suggest that IVIG treatment can reduce the need for exchange transfusion in neonatal isoimmune hemolytic jaundice by lowering hemolysis 4, 2
• Multiple doses of IVIG treatment may be more effective than a single dose in blocking ongoing hemolysis 4
• The efficacy of IVIG treatment may vary depending on the cause of the hemolytic disease, with better results seen in Rh hemolytic disease compared to ABO hemolytic disease 2
• IVIG treatment has been shown to be safe, with no significant side effects reported in the studies 2, 5
• However, one study found an association between IVIG treatment and an increased risk of necrotizing enterocolitis (NEC) in newborns with hemolytic disease 3