Phototherapy is the standard treatment in moderately severe
hemolytic disease of newborn (HDN), whereas exchange transfusion (ET) is the second line in progressive cases. Intravenous immunoglobin (
IVIG) has been suggested to decrease the need for ET. We aimed at assessing the efficacy of early two-dose regimens of
IVIG to avoid unnecessary ET in severe Rh HDN. The study included 90 full-term neonates with Rh incompatibility unmodified by antenatal treatment and not eligible for early ET and which were randomly assigned into one of three groups: group (I), treated by conventional method; groups IIa and IIb received
IVIG once at 12 h postnatal age if PT was indicated, in a dose of 0.5 and 1 g/kg, respectively. Analysis revealed 11 neonates (22%) in the conventional group and 2 (5%) in the intervention group who administered low-dose
IVIG at 12 h, while none in group IIb required exchange transfusion (p = 0.03). Mean
bilirubin levels were significantly lower during the first 96 h in the intervention group compared to the conventional group (p < 0.0001). Shorter duration of
phototherapy (52.8 ± 12.39 h) and
hospital stay (3.25 ± 0.71 days) in the
IVIG group compared to conventional group (84 ± 12.12 h and 4.72 ± 0.78 days, p < 0.0001, respectively) were observed. We conclude that
IVIG administration at 12 h was effective in the treatment of severe Rh HDN; the low-dose
IVIG (0.5 g/kg) was as effective as high dose (1 g/kg) in reducing the duration of
phototherapy and
hospital stay, but less effective in avoiding exchange transfusion.