title: Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11-year study.
abstract: Intravenous immunoglobulin (IVIG) is used to treat a variety of diseases in the neonatal intensive care unit (NICU). Although audits have reported on the spectrum of IVIG use in adults, the indications and utilization in neonates has not been investigated. The objectives of this study were to describe the usage pattern of and indications for IVIG in a tertiary care NICU.
  
  
  
  A retrospective chart review was performed of all neonates who received IVIG in the NICU from January 2003 to December 2013. Data collected included patient demographic features, antenatal maternal details, neonatal laboratory results, treatment details, adverse events, and patient outcome.
  
  
  
  Thirty-seven neonates received IVIG over the 11-year period. Twenty-three (67%) were treated for hemolytic disease of the newborn (HDN); 13 treatments were ABO related, six were anti-D related, and four were for clinically significant antibodies. Fourteen (33%) were treated for non-HDN causes, including eight for septic neonates, two for neonates with necrotizing enterocolitis, two for neonates with a clinically significant antibody but without evidence of hemolysis, and two for neonates with glucose 6-phosphate dehydrogenase deficiency. A complete hemolytic workup was not performed consistently before the receipt of IVIG.
  
  
  
  This novel assessment of IVIG use in the NICU revealed the spectrum of disease for which IVIG is ordered. This study also found that key diagnostic tests needed to confirm an immune etiology for idiopathic jaundice are not performed routinely before IVIG receipt. Neonatal transfusion-related databases are needed to carry out pragmatic clinical trials to establish better evidence-based guidelines for IVIG therapy in the NICU.
authors.affiliation: Department of Clinical Pathology, University Health Network.|Department of Clinical Pathology, Sunnybrook Health Sciences Centre.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.|Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Lani
authors.initials: L
authors.lastname: Lieberman
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Centre.
authors.forename: Jordan
authors.initials: J
authors.lastname: Spradbrow
authors.affiliation: Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Keir
authors.affiliation: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunn
authors.affiliation: Department of Clinical Pathology, University Health Network.|Department of Clinical Pathology, Sunnybrook Health Sciences Centre.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Clinical Pathology, University Health Network.|Department of Clinical Pathology, Sunnybrook Health Sciences Centre.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Callum
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000188:drug therapy; D004899:Erythroblastosis, Fetal / Q000188:drug therapy; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007567:Jaundice, Neonatal / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy; D062606:Tertiary Care Centers
chemical_list: D016756:Immunoglobulins, Intravenous