Anemia of Prematurity - Portal Neonatal

MEDICATION Section 7 of 11
Drug Category: Immunomodulators -- Normalize the antibody level in patients with primary
defective antibody synthesis. Prevent and treat certain bacterial and viral infections. Reduce the
immune-mediated hemolysis and phagocytosis.
Intravenous immunoglobulin (Gamimune, Gammagard,
Sandoglobulin, Gammar-P) -- Several studies have reported success
in minimizing the need for exchange transfusion in severe HDN with
IVIG. It is an effective adjunct to phototherapy. The mechanism of
action appears to be related to blockage of Fc receptors in the
neonatal reticuloendothelial system. Studies have also documented
Drug Name decreased hemolysis after administration of IVIG using
carboxyhemoglobin levels. Administration of IVIG in doses of 500-
1000 mg/kg in the first few hours of life to a newborn with severe
hemolysis should be considered. Its efficacy, however, depends on
timing of administration, duration of treatment, and severity of
hemolysis.
Adult Dose 1 g/kg IV qwk for maternal alloimmunization
0.5-1 g/kg IV in first few h following birth for severe hemolysis in
newborn; start infusion at rate of 0.01 mL/kg/min for 30 min, then
Pediatric Dose
increase q15-30min; not to exceed rate of 0.06 mL/kg/min; if adverse
reactions occur, reduce rate to a previously well-tolerated rate
Contraindications Documented hypersensitivity; IgA deficiency; anti-IgE/IgG antibodies
Globulin preparation may interfere with immune response to live virus
Interactions vaccine (MMR) and reduce efficacy (do not administer within 3 mo of
vaccine)
Pregnancy C - Safety for use during pregnancy has not been established.
Ensure that patient is not volume depleted before initiation of therapy;
periodic monitoring of renal function and urine output should be
undertaken in those at increased risk for developing acute renal
failure (eg, preexisting renal insufficiency, diabetes mellitus, age >65
y, hypovolemia, sepsis, paraproteinemia, those on nephrotoxic drugs);
in such patients, reduce rate of infusion and discontinue if renal
Precautions
function deteriorates; patients with agammaglobulinemia or extreme
hypogammaglobulinemia who have never received IVIG before or
have not received IVIG within preceding 8 wk are at increased risk of
developing inflammatory reaction after IVIG infusion (these reactions
are manifested by fever, chills, nausea, and vomiting and appear to
be related to rate of infusion)
FOLLOW-UP Section 8 of 11
Further Inpatient Care:
• The stabilization of a hydropic newborn requires a high level of intensive coordinated
management by a neonatal team well prepared for the possibly affected infant. In general,
immediate intubation followed by draining of pleural effusions and ascites results in immediate
improvement in respiratory gas exchange. A cautious correction of anemia with packed RBCs
or by exchange transfusion is necessary to prevent circulatory overload. These neonates have
normal blood volume but elevated central venous pressure. A close monitoring of metabolic