From the Guidelines
IVIG is recommended for neonatal hyperbilirubinemia in infants with isoimmune hemolytic disease and a total serum bilirubin (TSB) level rising in spite of intensive phototherapy or within 2-3 mg/dL of the exchange transfusion level. The primary indications for IVIG in neonatal hyperbilirubinemia are:
- Isoimmune hemolytic disease with a rising TSB level despite intensive phototherapy
- TSB levels approaching exchange transfusion thresholds
- Rapidly rising bilirubin levels despite intensive phototherapy
- To reduce the need for exchange transfusion Typical dosing is 0.5-1 g/kg given over 2 hours, which can be repeated in 12 hours if necessary, as stated in the study by 1. IVIG works by blocking antibody-mediated hemolysis, reducing the rate of bilirubin production, and is particularly effective in immune-mediated hemolytic disease. However, it should be used judiciously due to potential side effects and cost. Before administering IVIG, ensure proper diagnosis of immune-mediated hemolysis, rule out other causes of jaundice, and optimize conventional treatments like phototherapy, as suggested by 1. Monitor the infant closely for adverse reactions during and after infusion. IVIG is not a first-line treatment for routine neonatal jaundice and should be reserved for severe cases where the benefits outweigh the risks.
From the Research
Indications for Intravenous Immunoglobulin (IVIG) in Neonatal Hyperbilirubinemia
- IVIG is indicated in neonatal hyperbilirubinemia due to isoimmunization, such as ABO and Rh incompatibility 2, 3, 4
- IVIG can reduce the need for exchange transfusion in neonatal isoimmune hemolytic jaundice by lowering hemolysis 3, 4
- IVIG is effective in reducing jaundice in many but not all cases of neonatal isoimmunization, and its effectiveness depends on various factors, including the severity of hemolysis and the rate of bilirubin rise 2
- Multiple dose IVIG treatment may be more effective than single dose treatment in blocking ongoing hemolysis 3
- IVIG can be used in conjunction with phototherapy to reduce the severity of hyperbilirubinemia and prevent adverse outcomes, such as kernicterus and death 5, 4, 6
- The decision to use IVIG should be based on the severity of the hyperbilirubinemia, the presence of hemolysis, and the risk of adverse outcomes, as well as the availability of other treatment options, such as exchange transfusion 2, 3, 4