Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Authors

  • Sharath S. Ghalige Department of Neonatology, Madras Medical College, Chennai, Tamil Nadu, India
  • Vaideeswaran M. Department of Neonatology, Madras Medical College, Chennai, Tamil Nadu, India
  • Mangalabharathi S. Department of Neonatology, Madras Medical College, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20193747

Keywords:

Alloimmunisation, Intravenous Immunoglobulin, Neonates, Thrombocytopenia, Varicella

Abstract

Background: Intravenous Immunoglobulin (IVIG) is a blood product manufactured from pooled plasma. With increasing availability, an increased usage in neonates is being noted, though its utilisation has not been audited thoroughly. The objectives of this study are to describe the usage pattern and indications of IVIG and its outcome in a state-run tertiary care NICU.

Methods: This retrospective observational study was carried out at the inborn unit of Department of Neonatology, Madras Medical College, Chennai on a cohort of neonates who received IVIG over 3.5 years from January 2016 to June 2019. Data was collected from drug register, neonatal case records, exchange transfusion register and death register.

Results: Our study cohort had 55 neonates who received IVIG over 3.5 years. Indications for IVIG usage were Rh-alloimmunisation (23), ABO-alloimmunisation (7), prophylaxis of perinatal varicella (20), and other immune thrombocytopenia (5). Among 30 neonates with ABO-/Rh-incompatibility, 11 required exchange transfusion (ET). ET rates have shown a decreasing trend during this period. 2 babies with Rh-immunisation and Hydrops expired. None of the babies given prophylaxis for perinatal varicella manifested the disease. Neonates treated for immune thrombocytopenia were successfully discharged.

Conclusions: This study shows the IVIG usage pattern in a tertiary care neonatal unit. In neonates with Hemolytic disease due to Rh-/ABO-alloimmunisation treated with IVIG, a reduction in rates of exchange transfusion has been noted. IVIG is being used increasingly for prophylaxis of perinatal varicella and immune related thrombocytopenia with promising benefits. It is prudent to have SOPs for IVIG administration with standardised issue and transfusion forms for documentation to regulate its judicious use.

 

References

Navarro M, Negre S, Golombek S, Matoses ML, Vento M. Intravenous immune globulin: clinical applications in the newborn. Neo Reviews. 2010;11(7):e370-8.

National Blood Authority (NBA). Patient Blood Management Guidelines: Module 6 – Neonatal and Paediatrics. NBA, Canberra, Australia. 2016. Available at: https://www.blood.gov.au/pbm-module-6. Accessed 29 April 2016.

The INIS Collaborative Group. Treatment of Neonatal Sepsis with Intravenous Immunoglobuin. N Engl J Med. 2011;365:1201-11.

Ohlsson A, Lacy JB. Intravenous immunoglobulin for suspected or proven infection in neonates. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD001239. DOI: 10.1002/14651858.CD001239.pub5

Lieberman L, Spradbrow J, Keir A, Dunn M, Lin Y, Callum J. Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11‐year study. Transfusion. 2016;56(11):2704-11.

Santos MC, Sa C, Gomes SC Jr, Camacho LA, Moreira ME. The efficacy of the use of intravenous human immunoglobulin in Brazilian newborns with rhesus hemolytic disease: a randomized double-blind trial. Transfusion 2013;53(4):777-82.

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.

Zwiers C, Scheffer-Rath MEA, Lopriore E, de Haas M, Liley HG. Immunoglobulin for alloimmune hemolytic disease in neonates. Cochrane Database Syst Rev. 2018;18;3:CD003313.

Huang YC, Lin TY, Lin YJ, Lien RI, Chou YH. Prophylaxis of intravenous immunoglobulin and acyclovir in perinatal varicella Eur J Pediatr. 2001;160(2):91-4.

van der Lugt NM, van Kampen A, Walther FJ, Brand A, Lopriore E. Outcome and management in neonatal thrombocytopenia due to maternal idiopathic thrombocytopenic purpura. Vox Sang. 2013;105(3):236-43.

Bayhan T, Tavil B, Korkmaz A, Unal S, Hanalioglu D, Yigit S, et al. Neonates born to mothers with immune thrombocytopenic purpura: a single-center experience of 20 years. Blood Coagul Fibrinolysis. 2016;27(1):19-23.

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Published

2019-08-23

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Original Research Articles