The Effect of Intravenous Immunoglobulin in Newborns with Hemolytic Disease Due to ABO Incompatibility

Abstract

Objective: To determine the efficacy of intravenous immunoglobulin (IVIG) in reducing the need for exchange transfusion (ET) in neonates with ABO hemolytic disease of the newborn (HDN).

Methodology: This prospective cohort study was conducted at Neonatal ICU of Bahawal Victoria Hospital, Bahawalpur, from January 2023 to July 2023. Term neonates with significant hyperbilirubinemia due to ABO incompatibility and a positive direct Coombs test were enrolled. Eligible infants were allocated into two groups: Group A received intensive phototherapy plus IVIG (1 g/kg), while Group B received intensive phototherapy alone. Baseline demographic and clinical parameters, serum bilirubin levels, need for ET, and immediate adverse effects were recorded. Data were analyzed using chi-square and t-tests, with p < 0.05 considered statistically significant.

Results: A total of 30 neonates were included, 15 in each group. The need for ET was significantly lower in the IVIG group (26.7%) compared to the phototherapy-only group (66.7%) (p = 0.028). No significant differences were observed in baseline characteristics between groups. No immediate adverse effects related to IVIG were noted.

Conclusion: Administration of IVIG in addition to phototherapy significantly reduces the need for ET in  term neonates with ABO hemolytic disease, without immediate complications. These results support its role as an effective adjunctive therapy in managing severe hyperbilirubinemia.