NEW YORK (Reuters Health) – Although prophylactic intravenous immune globulin (IVIg) is recommended for neonates with rhesus hemolytic disease, it does not improve outcomes or lessen the need for exchange transfusion, according to a new study.
Writing in the April issue of Pediatrics, Dr. Vivianne E. H. J. Smits-Wintjens, at Leiden University Medical Center, the Netherlands, and colleagues note that treatment of rhesus hemolytic disease of the neonate consists of intensive phototherapy and exchange transfusion. “However, exchange transfusion is a high-risk invasive procedure associated with a significant rate of adverse effects.”
Neonatal treatment with IVIg has been proposed as an alternative therapy to exchange transfusion — and is widely used — but the recommendation is controversial, the authors explain.
To investigate, they conducted a prospective trial in 80 infants with rhesus hemolytic disease who received conventional intensive phototherapy directly after birth and were randomly assigned to receive a single prophylactic IVIg dose of 0.75 g/kg or an equal amount of a 5% glucose intravenous infusion, administered within the first 4 hours after birth.
“At least 1 exchange transfusion was required in 17% (7 of 41) of the neonates in the IVIg group compared with 15% (6 of 39) in the placebo group (p=0.99),” the researchers report.
Furthermore, there was also no significant difference between the IVIg and placebo groups in the duration of phototherapy (4.7 vs 5.1days), peak bilirubin levels (14.8 vs 14.1 mg/dL), or the percentage of infants requiring top-up red-cell transfusions (83% vs 87%), Dr. Smits-Wintjens and colleagues found.
They conclude, “Our findings do not support the current recommendations of the AAP (American Academy of Pediatrics) to use IVIg in neonates with rhesus hemolytic disease. In view of the absence of beneficial effects, the use of IVIg for this indication should be discouraged.”
Reference:
Intravenous Immunoglobulin in Neonates With Rhesus Hemolytic Disease: A Randomized Controlled Trial
Pediatrics 2011;127:680–686.
