They effective than single doses in combatting hemolysis and

They appear to act by blockage of Fc receptors in the
neonatal reticuloendothelial  system.
Effective adjunct to phototherapy. Reduce need for exchange transfusion
duration of hospital stay  and
phototherapy. Multiple doses are more effective than single doses in combatting
hemolysis  and reducing risk of late
anemia.

Doses: 500-1000 mg/kg in the first few hours of life to a
newborn with severe hemolysis

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Example:

Intravenous immunoglobulin (Gamimune, Gammagard,
Sandoglobulin, Gammar-P)

Intravenous immunoglobulin (Gamimune, Gammagard,
Sandoglobulin, Gammar-P)

Colony-stimulating Factor: Mimics biological activity of
human urinary erythropoietin. Used for anemia.

Example:

Epoetin alfa, recombinant (Epogen, Procrit) Epoetin alfa,
recombinant (Epogen, Procrit)

 

 

 

Exchange Transfusions:

Before the development of intervention measures in the form
of exchange transfusions the perinatal mortality rate was 50 %. The idea of
exchange transfusions was introduced by Wallerstein in 1945 reducing the
mortality rate to 25%.Later the idea of delivery of severely infected non
hydrophobic fetuses before 34 weeks was suggested   followed by prompt transfusion.
Intraperitoneal and intravascular transfusions introduced in 1963 and 1981
respectively further reduced mortality rate to 16 %.

This process replaces antibody covered erythrocytes with
erythrocytes which have compatibility with maternal circulation. It also
removes bilirubin and provides albumin with binding sites for bilirubin.This is
a time consuming procedure but no other effective treatment is available for
kernicterus. About 70-90 % of fetal erythrocytes are removed through this
process. As only 75 % of bilirubin is present in extravascular space only 25 %
of bilirubin is removed through this process.

Indications for exchange transfusion include:

Ø 
Severe anemia (Hb < 10 g/dL) Ø  Cord bilirubin > 4 mg/dL.

Ø 
Rate of bilirubin rises more than 0.5 mg/dL
despite intensive phototherapy

Ø 
Severe hyperbilirubinemia

Ø 
Serum bilirubin-to-albumin ratio exceeding
levels that are considered safe

However exchange tranfusions in neonates can cause sepsis (8
%), severe thrombocytopenia ( 63 %), leukocytopenia (88 %), hypernatremia (8 %)
and hypocalcemea  (22%), apnea, bradycardia,
cyanosis, vasospasm,  hypothermia
and  hypoglycemia.

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