From the Guidelines
Intravenous immunoglobulin (IVIG) administration in neonates is recommended for specific conditions, including hemolytic disease of the newborn and neonatal alloimmune thrombocytopenia, at a standard dose of 0.5-1 g/kg, typically administered as a single dose infused over 2 hours, as supported by the most recent evidence 1.
Key Considerations
- The decision to administer IVIG in neonates should be based on the underlying condition, such as hemolytic disease of the newborn or neonatal alloimmune thrombocytopenia.
- For hemolytic disease, IVIG should be given when serum bilirubin is rising despite intensive phototherapy or approaching exchange transfusion levels, as recommended in the management of hyperbilirubinemia in newborn infants 1.
- For neonatal alloimmune thrombocytopenia, IVIG is given when platelet counts fall below 20,000/μL or with active bleeding, with a recommended dose of 1 g/kg, which may be repeated if necessary 1.
Administration and Monitoring
- During administration, the infant should be closely monitored for vital signs, particularly heart rate and blood pressure.
- Potential adverse effects include fluid overload, hypotension, tachycardia, and rarely anaphylaxis.
- The infusion rate should start slowly and can be increased gradually if well tolerated.
Mechanism of Action
- IVIG works by blocking Fc receptors on macrophages, reducing the destruction of antibody-coated cells, and providing passive immunity in cases of infection.
- Repeated doses may be necessary depending on the clinical response, typically given 12-24 hours apart if needed, as supported by the evidence 1.
From the Research
Ivig Administration in Neonates
- Ivig administration in neonates has been proposed for managing conditions 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 2
- 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 2
- A study found that early IVIG therapy may be beneficial for survival in severe neonatal enterovirus infections, with a higher nadir hemoglobin level, no concurrent myocarditis, and early IVIG therapy being independently associated with a favorable prognosis 3
- IVIG has been shown to have immunomodulatory functions in inflammatory and autoimmune diseases, including Kawasaki disease, immune thrombocytopenia, and Guillain-Barré syndrome 4
- A Cochrane review found that IVIG administration may reduce mortality in infants with suspected or subsequently proven infection, but the evidence is still insufficient to support routine administration 5
- Another Cochrane review found that IVIG administration results in a 3% reduction in sepsis and a 4% reduction in one or more episodes of any serious infection in preterm and/or low birth weight infants, but is not associated with reductions in other clinically important outcomes, including mortality 6
Indications for Ivig Administration
- 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
- Some types of immunodeficiency