. In the presence of Rh, ABO, or other blood group incompatibilities that cause significant neonatal jaundice, IVIG has been shown to significantly reduce the need for exchange transfusions.

Intravenous immune globulin

In recent years, IVIG has been used for numerous immunologically mediated conditions. In the presence of Rh, ABO, or other blood group incompatibilities that cause significant neonatal jaundice, IVIG has been shown to significantly reduce the need for exchange transfusions. However, it must be recognized that some studies have failed to show efficacy. The reasons for this discrepancy have not been explained. One can speculate that differences in the origin and characteristics of the IVIG preparation could play a role. If one particular IVIG preparation appears not to work, it may be worthwhile to try IVIG from a different source/manufacturer.

The 2004 AAP guidelines suggest a dose range for IVIG of 500-1000 mg/kg.^[35]

The author routinely uses 500 mg/kg infused intravenously over a period of 2 hours for Rh or ABO incompatibility when the total serum bilirubin levels approach or surpass the exchange transfusions limits. The author has, on occasion, repeated the dose 2-3 times. In most cases, when this is combined with intensive phototherapy, avoiding exchange transfusion is possible. In the authors' institution, with about 750 NICU admissions per year, the use of exchange transfusions has decreased to 0-2 per year following the implementation of IVIG therapy for Rh and ABO isoimmunization.^[33] The author does not use IVIG in the presence ofhydrops. Anecdotally, IVIG appears less likely to be successful when the infant is anemic (Hb < 10 g/dL).