The efficacy of the use of intravenous human immunoglobulin in Brazilian newborns with rhesus hemolytic disease: a randomized double-blind trial
Article first published online: 6 AUG 2012
© 2012 American Association of Blood Banks
Volume 53, Issue 4, pages 777–782, April 2013
How to Cite
Santos, M. C., Sá, C., Gomes Jr, S. C., Camacho, L. A. and Moreira, M. E. (2013), The efficacy of the use of intravenous human immunoglobulin in Brazilian newborns with rhesus hemolytic disease: a randomized double-blind trial. Transfusion, 53: 777–782. doi: 10.1111/j.1537-2995.2012.03827.x
- Issue published online: 8 APR 2013
- Article first published online: 6 AUG 2012
- Received for publication March 13, 2012; revision received June 19, 2012, and accepted June 19, 2012.
BACKGROUND: The purpose of this study was to evaluate the efficacy of intravenous human immunoglobulin (IVIG) in the presence of high-intensity phototherapy in decreasing the need for exchange transfusion in newborns with rhesus hemolytic disease.
STUDY DESIGN AND METHODS: We performed a randomized, double-blind, placebo-controlled trial. The trial included D+ newborns born at 32 weeks of gestational age or later with a positive direct antiglobulin test and whose mothers were Rh-alloimmunized and did or did not receive intrauterine transfusion. The newborns were randomly assigned to receive either IVIG at a dose of 500 mg/kg or placebo (saline solution, 10 mL/kg) during the first 6 hours of life. The primary outcome was the need for exchange transfusion. The criteria for exchange transfusion were total serum bilirubin (TSB) level at or above 340 µmol/L (20 mg/dL) or increasing by 8.5 µmol/L/hr (0.5 mg/dL/hr) despite intensive phototherapy.
RESULTS: The trial included 92 newborns. There was no difference in the rate of exchange transfusion between groups: 6 of 46 (13%) in the IVIG group versus 7 of 46 (15.2%) in the placebo group (p = 0.765). There were no significant differences between groups with respect to their need for exchange transfusion, phototherapy time, peak bilirubin, or length of hospital stay. There were no adverse events related to the drug or the form of administration.
CONCLUSION: Nonspecific human immunoglobulin was not effective in preventing the need for exchange transfusion in neonates with rhesus hemolytic disease.