Intravenous immunoglobulin and necrotizing enterocolitis in newborns with hemolytic disease

The objective of this study was to assess whether the use of high-dose intravenous immunoglobulin (IVIG) in late-preterm and term newborns with severe isoimmune hemolytic jaundice caused by Rh and ABO incompatibility was a risk factor for necrotizing enterocolitis (NEC).

An observational, retrospective study that encompassed 16 years was conducted. A total of 492 liveborn infants who were of >or=34 weeks' gestation and had severe isoimmune hemolytic jaundice caused by Rh (n = 91) and ABO (n = 401) incompatibility and were treated with phototherapy were included in the study. IVIG (500 mg/kg over 2-4 hours) was indicated when total serum bilirubin level plus 2 points reached 85% of the cutoff value for performing exchange transfusion.

A total of 167 (34%) infants received IVIG. NEC was diagnosed in 11 (2.2%) patients: 10 (6%) in the IVIG-treated group and 1 (0.3%) in the non-IVIG-treated group. Five patients required urgent operation, and 1 of them died as a result of massive intestinal necrosis. Another patient died 2 years later as a result of short bowel syndrome. In the multivariate analysis, cesarean delivery (odds ratio [OR]: 3.76 [95% confidence interval (CI): 1.10-12.90), Apgar test at 5 minutes (OR: 0.50 [95% CI: 0.40-0.64), and IVIG (OR: 31.66 [95% CI: 3.25-308.57]) were independent factors significantly associated with NEC.

The use of high-dose IVIG for severe isoimmune hemolytic jaundice in late-preterm and term infants was associated with a higher incidence of NEC.