Efficacy of Intravenous Immunoglobulin in Management of Rh and ABO Incompatibility Disease
Efficacy of Intravenous Immunoglobulin in Management of Rh and ABO Incompatibility Disease
hemolytic disease of newborn is an important cause of hyperbilirubinemia with significant
 morbidity and mortality in neonatal period. intravenous immunoglobulin has widely used in
 management of hemolytic disease of new born
Hemolytic disease of the newborn (HDN) due to red cell alloimmunisation is an important cause
 of hyperbilirubinemia with significant morbidity in the neonatal period . Hemolytic disease
 of the newborn has unfortunately continued to contribute to perinatal and neonatal morbidity
 and mortality in developing countries . The degree to which the fetus is affected correlated
 with the amount of maternal antibody that cross the placenta .

 Hemolysis from ABO incompatibility is one of the most common cause of isoimmune hemolytic
 disease during neonatal period. Infants with blood group type A or B , carried by blood group
 type O mother, will have a positive antibody because of maternal anti-A or anti-B transfer in
 to the fetal circulation. Ten percent of these infants will present with hemolytic disease .
 Most of the infant presents with unconjugated hyperbilirubinemia in the first 24 h of life
 and it is rarely a cause in patients who are discharged from nursery and readmit with severe
 hyperbilirubinemia.

 Rh incompatibility can occur when an Rh-negative pregnant mother is exposed to Rh-positive
 fetal red blood cells secondary to fetomaternal hemorrhage during the course of pregnancy
 from spontaneous or induced abortion , trauma, invasive obstetric procedures, or normal
 delivery. As a consequence, blood from the fetal circulation, and, after a significant
 exposure, sensitization occurs leading to maternal antibody production against the foreign Rh
 antigen. Once produced, maternal Rh immunoglobulin G (IgG) antibodies may cross freely from
 the placenta to the fetal circulation, where they form antigen-antibody complexes with Rh-
 positive fetal erythrocytes and eventually are destroyed, resulting in a fetal
 alloimmune-induced hemolytic anemia and Jaundice.

 Traditional neonatal treatment of HDN consists of intensive phototherapy and exchange
 transfusion (ET). However, ET is a high-risk invasive procedure associated with a significant
 rate of adverse effects .Although the mortality rate associated with ET is currently reported
 to be less than 0.3% in term infants , the morbidity rates can reach 74% and includes
 catheter-related complications, sepsis, thrombocytopenia and hypocalcemia

 Intravenous Immunoglobulin G (IVIG) therapy has been widely used for a variety of indications
 in newborn period such as alloimmune neonatal thrombocytopenia and an adjunctive treatment of
 neonatal infections. American Academy of Pediatrics, recommends high dose IVIG (0.5_1 g/kg)
 as an additional treatment of Rh and ABO hemolytic disease and its use however there is no
 consensus on its routine use in ABO hemolytic disease yet .

 IVIG "contains a spectrum of antibodies capable of interacting with and altering the activity
 of cells of the immune system as well as antibodies capable of reacting with cells such as
 erythrocytes". When hemolytic disease occurs, maternal antibodies present in the infant's
 blood attach to the antigen receptors on the infant's red blood cells. Specifically, the
 maternal antibody attaches its Fc region, the lower portion of the antigen, to specific
 immune system cells , such as machrophages, stimulating the destruction of the
 antigen-antibody complex and the red blood cell. It has been proposed that IVIG blocks the Fc
 receptor and therefore blocks the binding of the antibody to the antigen. With this blockade,
 hemolysis no longer occurs.

 Neonatal treatment with intravenous immunoglobulin (IVIG) has been suggested as an altenative
 therapy to ET for isoimmune hemolytic jaundice to reduce the need for exchange transfusion
 and duration of phototherapy and hospitalization in isoimmune hemolytic disease of the
 newborn.
Inclusion Criteria:

 -  1)Gestational age more than or equal 37 weeks and postnatal age from 48hr-72hr.

 2)Anemia with Reticulocytic count 10% 3)Serum total bilirubin around 18mg/dl .

 Exclusion Criteria:

 -  1)perinatal asphyxia. 2)Congenital malformation. 3)Severe respiratory distress.
 4)Sepsis during hospital stay. 5)Metabolic problems . 6)Gestational age less than 37
 weeks