Neonatal uses of intravenous immunoglobulin

Intravenous gamma-globulin (IVGG) has several potential uses in neonates. A considerable amount of study is going into the evaluation of its role in neonatal sepsis. Preliminary results from two large controlled trials suggest that there may be a reduction in nosocomial sepsis following infusion of intravenous immunoglobulin (IVIG) in small premature infants, but the data are still incomplete. It is important to distinguish the two types of neonatal immune thrombocytopenia. In maternal autoimmune disease, neonatal intracranial hemorrhage has an incidence of only 1-2%, and treatment can be initiated postnatally in the thrombocytopenic neonate. Since antenatal hemorrhage is very rare, treatment of the mother for the sake of the fetus seems unnecessary. In alloimmune thrombocytopenia, on the other hand, intracranial hemorrhages occur in approximately 20% of all identified cases, and as many as one-half of these occur antenatally. Pilot studies of maternally administered IVGG have indicated that it may elevate the fetal platelet count and prevent intracranial hemorrhage.