Skip to main content
PMC home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2003 Jan;88(1):F6–F10. doi: 10.1136/fn.88.1.F6

Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn

R Gottstein, R Cooke
PMCID: PMC1755998  PMID: 12496219

Abstract

Design: Systematic review of randomised and quasi-randomised controlled trials comparing HDIVIG and phototherapy with phototherapy alone in neonates with Rh and/or ABO incompatibility.

Results: Significantly fewer infants required exchange transfusion in the HDIVIG group (relative risk (RR) 0.28 (95% confidence interval (CI) 0.17 to 0.47); number needed to treat 2.7 (95% CI 2.0 to 3.8)). Also hospital stay and duration of phototherapy were significantly reduced.

Conclusion: HDIVIG is an effective treatment.

Full Text

The Full Text of this article is available as a PDF (234.2 KB).

Figure 1 .

Figure 1

Open in a new tab

Number of infants requiring exchange transfusions when comparing high dose intravenous immunoglobulin (HDIVIG) with phototherapy alone.

Figure 2 .

Figure 2

Open in a new tab

Number of infants requiring exchange transfusion when comparing high dose intravenous immunoglobulin with phototherapy alone (Rh disease only).

Figure 3 .

Figure 3

Open in a new tab

Number of infants requiring multiple exchange transfusions when comparing high dose intravenous immunoglobulin with phototherapy alone.

Figure 4 .

Figure 4

Open in a new tab

Mean length of hospital stay when comparing high dose intravenous immunoglobulin with phototherapy alone. WMD, Weighted mean difference.

Figure 5 .

Figure 5

Open in a new tab

Mean duration of phototherapy when comparing high dose intravenous immunoglobulin with phototherapy alone. WMD, Weighted mean difference.

Figure 6 .

Figure 6

Open in a new tab

Number of infants requiring red cell transfusions for late anaemia when comparing high dose intravenous immunoglobulin with phototherapy alone.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alpay F., Sarici S. U., Okutan V., Erdem G., Ozcan O., Gökçay E. High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice. Acta Paediatr. 1999 Feb;88(2):216–219. doi: 10.1080/08035259950170420. [DOI] [PubMed] [Google Scholar]
  2. Bolton-Maggs P. H., Moon I. Assessment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines. Lancet. 1997 Aug 30;350(9078):620–623. doi: 10.1016/s0140-6736(97)04143-3. [DOI] [PubMed] [Google Scholar]
  3. Burks A. W., Sampson H. A., Buckley R. H. Anaphylactic reactions after gamma globulin administration in patients with hypogammaglobulinemia. Detection of IgE antibodies to IgA. N Engl J Med. 1986 Feb 27;314(9):560–564. doi: 10.1056/NEJM198602273140907. [DOI] [PubMed] [Google Scholar]
  4. Bussel J. B., Berkowitz R. L., Lynch L., Lesser M. L., Paidas M. J., Huang C. L., McFarland J. G. Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: a randomized trial of the addition of low-dose steroid to intravenous gamma-globulin. Am J Obstet Gynecol. 1996 May;174(5):1414–1423. doi: 10.1016/s0002-9378(96)70582-3. [DOI] [PubMed] [Google Scholar]
  5. Chitkara U., Bussel J., Alvarez M., Lynch L., Meisel R. L., Berkowitz R. L. High-dose intravenous gamma globulin: does it have a role in the treatment of severe erythroblastosis fetalis? Obstet Gynecol. 1990 Oct;76(4):703–708. [PubMed] [Google Scholar]
  6. Dağoğlu T., Ovali F., Samanci N., Bengisu E. High-dose intravenous immunoglobulin therapy for rhesus haemolytic disease. J Int Med Res. 1995 Jul-Aug;23(4):264–271. doi: 10.1177/030006059502300406. [DOI] [PubMed] [Google Scholar]
  7. Dooren M. C., van Kamp I. L., Scherpenisse J. W., Brand R., Ouwehand W. H., Kanhai H. H., Engelfriet C. P., Gravenhorst J. B. No beneficial effect of low-dose fetal intravenous gammaglobulin administration in combination with intravascular transfusions in severe Rh D haemolytic disease. Vox Sang. 1994;66(4):253–257. doi: 10.1111/j.1423-0410.1994.tb00324.x. [DOI] [PubMed] [Google Scholar]
  8. Duhem C., Dicato M. A., Ries F. Side-effects of intravenous immune globulins. Clin Exp Immunol. 1994 Jul;97 (Suppl 1):79–83. [PMC free article] [PubMed] [Google Scholar]
  9. Fehr J., Hofmann V., Kappeler U. Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. N Engl J Med. 1982 May 27;306(21):1254–1258. doi: 10.1056/NEJM198205273062102. [DOI] [PubMed] [Google Scholar]
  10. Healey C. J., Sabharwal N. K., Daub J., Davidson F., Yap P. L., Fleming K. A., Chapman R. W., Simmonds P., Chapel H. Outbreak of acute hepatitis C following the use of anti-hepatitis C virus--screened intravenous immunoglobulin therapy. Gastroenterology. 1996 Apr;110(4):1120–1126. doi: 10.1053/gast.1996.v110.pm8613001. [DOI] [PubMed] [Google Scholar]
  11. Howard H., Martlew V., McFadyen I., Clarke C., Duguid J., Bromilow I., Eggington J. Consequences for fetus and neonate of maternal red cell allo-immunisation. Arch Dis Child Fetal Neonatal Ed. 1998 Jan;78(1):F62–F66. doi: 10.1136/fn.78.1.f62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Imbach P., Barandun S., d'Apuzzo V., Baumgartner C., Hirt A., Morell A., Rossi E., Schöni M., Vest M., Wagner H. P. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Lancet. 1981 Jun 6;1(8232):1228–1231. doi: 10.1016/s0140-6736(81)92400-4. [DOI] [PubMed] [Google Scholar]
  13. Jadad A. R., Rennie D. The randomized controlled trial gets a middle-aged checkup. JAMA. 1998 Jan 28;279(4):319–320. doi: 10.1001/jama.279.4.319. [DOI] [PubMed] [Google Scholar]
  14. Keenan W. J., Novak K. K., Sutherland J. M., Bryla D. A., Fetterly K. L. Morbidity and mortality associated with exchange transfusion. Pediatrics. 1985 Feb;75(2 Pt 2):417–421. [PubMed] [Google Scholar]
  15. Ouwehand W. H., Smith G., Ranasinghe E. Management of severe alloimmune thrombocytopenia in the newborn. Arch Dis Child Fetal Neonatal Ed. 2000 May;82(3):F173–F175. doi: 10.1136/fn.82.3.F173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rübo J., Albrecht K., Lasch P., Laufkötter E., Leititis J., Marsan D., Niemeyer B., Roesler J., Roll C., Roth B. High-dose intravenous immune globulin therapy for hyperbilirubinemia caused by Rh hemolytic disease. J Pediatr. 1992 Jul;121(1):93–97. doi: 10.1016/s0022-3476(05)82551-x. [DOI] [PubMed] [Google Scholar]
  17. Rübo J., Wahn V. Hochdosierte Immunglobulintherapie der Hyperbilirubinämie bei Rhesusinkompatibilität. Infusionsther Transfusionsmed. 1993 Apr;20 (Suppl 1):104–109. [PubMed] [Google Scholar]
  18. Stanley T. V., Grimwood K. Classical Kawasaki disease in a neonate. Arch Dis Child Fetal Neonatal Ed. 2002 Mar;86(2):F135–F136. doi: 10.1136/fn.86.2.F135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Urbaniak S. J. ADCC (K-cell) lysis of human erythrocytes sensitized with rhesus alloantibodies. II. Investigation into the mechanism of lysis. Br J Haematol. 1979 Jun;42(2):315–325. doi: 10.1111/j.1365-2141.1979.tb01135.x. [DOI] [PubMed] [Google Scholar]
  20. Voto L. S., Mathet E. R., Zapaterio J. L., Orti J., Lede R. L., Margulies M. High-dose gammaglobulin (IVIG) followed by intrauterine transfusions (IUTs): a new alternative for the treatment of severe fetal hemolytic disease. J Perinat Med. 1997;25(1):85–88. doi: 10.1515/jpme.1997.25.1.85. [DOI] [PubMed] [Google Scholar]
  21. Voto L. S., Sexer H., Ferreiro G., Tavosnanska J., Orti J., Mathet E. R., Margulies M., Margulies M. Neonatal administration of high-dose intravenous immunoglobulin in rhesus hemolytic disease. J Perinat Med. 1995;23(6):443–451. doi: 10.1515/jpme.1995.23.6.443. [DOI] [PubMed] [Google Scholar]
  22. Wenske G., Gaedicke G., Heyes H. Idiopathic thrombocytopenic purpura in pregnancy and neonatal period. Blut. 1984 Jun;48(6):377–382. doi: 10.1007/BF00319966. [DOI] [PubMed] [Google Scholar]
  23. Yap P. L. Intravenous immunoglobulin and hepatitis C virus: an overview of transmission episodes with emphasis on manufacturing data. Clin Ther. 1996;18 (Suppl B):43–58. doi: 10.1016/s0149-2918(96)80195-0. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES