The recently published ‘Clinical Practice Guideline’ by the American Academy of Pediatrics entitled: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation (PDF) states in one of its recommendations:

“RECOMMENDATION 7.1.4: In isoimmune hemolytic disease, administration of intravenous globulin (0.5-1g/kg over 2 hours) is recommended if the total serum bilirubin is rising despite intensive phototherapy or the total serum bilirubin level is within 2 to 3 mg/dL (34-51 mol/L) of the exchange level. If necessary, this dose can be repeated in 12 hours (evidence quality B: benefits exceed harms). Intravenous globulin has been shown to reduce the need for exchange transfusions in Rh and ABO hemolytic disease”. The following references are cited to substantiate the aforementioned claim:

• Sato, K et al. High-dose intravenous gammaglobulin therapy for neonatal immune haemolytic jaundice due to blood group incompatibility. Acta Paediatr Scand. 1991 Feb;80(2):163-6.
• Gottstein, R; Cooke, RWI. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed. 2003 Jan;88(1):F6-10.
• Rubo, J et al. High-dose intravenous immune globulin therapy for hyperbilirubinemia caused by Rh hemolytic disease. J Pediatr. 1992 Jul;121(1):93-7.
• Hammerman, C et al. Intravenous immune globulin in neonatal immune hemolytic disease: does it reduce hemolysis? Acta Paediatr. 1996 Nov;85(11):1351-3.

A colleague in Los Angeles wonders if others are in fact using infusions of IV Immune Globulin to reduce the need for exchange transfusion in neonates at risk of Rh and ABO HDN, and if so, what protocols are followed?

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator