Journal of Clinical Neonatology

LETTER TO EDITOR
Year
: 2021  |  Volume : 10  |  Issue : 4  |  Page : 255--256

Considerations for intravenous immunoglobulin infusion in neonates


Majid Malaki 
 Pediatric Ward, Sevome Shaban Hospital, Tehran, Iran

Correspondence Address:
Majid Malaki
Sevome Shaban Hospital, Tehran
Iran




How to cite this article:
Malaki M. Considerations for intravenous immunoglobulin infusion in neonates.J Clin Neonatol 2021;10:255-256


How to cite this URL:
Malaki M. Considerations for intravenous immunoglobulin infusion in neonates. J Clin Neonatol [serial online] 2021 [cited 2022 Jan 16 ];10:255-256
Available from: https://www.jcnonweb.com/text.asp?2021/10/4/255/326618


Full Text



Sir,

Intravenous immunoglobulin (IVIG) is a useful drug for several diseases and in newborn, it is used for jaundice following of isoimmune hemolytic reactions. Studies show benefits of IVIG as prophylaxis against exchange transfusion (ET) but these studies have different protocols for the time (lethal bilirubin level) and method of IVIG infusion (0.5 g/kg to 1 g/kg) in every session, one dose to 3 doses courses, infusion time from over 2 h or over 4. These studies are associated with discrepancies in optimum delivered doses and quality of infusion, but they confirm the efficacy of IVIG in jaundice due to Rh incompatibility and not for ABO hemolysis; Cochrane study shows that such studies are insufficient because of their bias, and few less bias studies deny the efficacy of IVIG in jaundice and further less biased studies with new standards and focus on short-term and long-term adverse effects of IVIG is necessary, keep in mind that insisting on IVIG efficacy and excessive consumption of IVIG instead of ET can lead to (late) top-up transfusion and increase early and late adverse effects.[1],[2] While.

IVIG-related adverse effects is well known in adults partly due to increase plasma viscosity and incomplete removing of some factors by some brands as predisposing factors for thrombotic events.[3] IVIG is currently used in all age groups but the Food and Drug Administration has not approved it for newborn group;[4] it may be related to the high risk of thromboemboli in 0.5%–15% of adults from 1st day up to 1 month after infusion by known and unknown mechanisms[3] Navarro et al. reported three cases of necrotizing enterocolitis (NEC) who received nonsucrose based IVIG up to 60 h after birth, they developed NEC 6–18 h after slow infusion (from 4 to 8 h), except one who received lower dose (500 mg/kg over 8 h) that managed medically in a shorter period.[4] It is a warning alarm if we know that 34% of newborns with isoimmune hemolytic anemia receive IVIG and NEC can be met in 2%; a catastrophic event that may occur in risky groups includes low APGAR score, delivery by cesarean section, and higher doses of IVIG, while its benefit in ABO hemolytic disease is debatable after receiving higher doses.[5],[1] Most of reported neonates who received 500 mg/kg/dose over 2–4 h, they developed NEC from 2 h up to 126 h later and slow infusion (over 4 h) can reduce the effects of hyperviscosity as an inciting factor for adverse effects,[6] but this method is an acceptable infusion protocol in most studies and there is not any research to compare infusion method and the rate of NEC occurrence.

 Conclusion



It is time to focus on side effects and techniques of IVIG infusion. Clinical indications for IVIG infusion should be narrowed if not many short and long-term side effects can be attributed to our ignorance.

Acknowledgment

I dedicate this article to Dr. Mohammad Mosadegh God bless his soul.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Santos MC, Sá CA, Gomes SC, Camacho LA, Moreira ME. Is intravenous immunoglobulin effective to reduce exchange transfusion in Rhesus haemolytic disease of the newborn? ISBT Sci Ser 2011;6:219-22.
2Zwiers C, Scheffer-Rath ME, Lopriore E, de Haas M, Liley HG. Immunoglobulin for Alloimmune hemolytic disease in neonates. Cochrane Database Syst Rev 2018;3:CD003313.
3Ammann EM, Jones MP, Link BK, Carnahan RM, Winiecki SK, Torner JC, et al. Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy. Blood 2016;127:200-7.
4Navarro M, Negre S, Matoses ML, Golombek SG, Vento M. Necrotizing enterocolitis following the use of intravenous immunoglobulin for haemolytic disease of the newborn. Acta Paediatr 2009;98:1214-7.
5Figueras-Aloy J, Rodríguez-Miguélez JM, Iriondo-Sanz M, Salvia-Roiges MD, Botet-Mussons F, Carbonell-Estrany X. Intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease. Pediatrics 2010;125:139-44.
6Navarro M, Negre S, Golombek S, Matoses ML, Vento M. Intravenous immune globulin: Clinical applications in the newborn. Neo Rev 2010;11:e370-8.