Dear colleagues,

In relation to cope with hyperbilirubinemia in term babies, we have managed to order Kiovig 10% Intravenous Immunoglobulin I have had some though time trying to understand the dosage, could you possibly help with the dosage? Do you have protocols for Kiovig?

And also do you have some protocols for so called IVIG usage for neonates?

I am not familiar with this practice and indication, but here are some points that might help you 'connect the dots':

• This clinical practice guideline by the American Academy of Pediatrics (2022) includes a recommendation for IVIG therapy in Key Action Statements (KAS) 21: "Intravenous immune globulin (IVIG; 0.5 to 1 g/kg) over 2 hours may be provided to infants with isoimmune hemolytic disease (ie, positive DAT) whose TSB reaches or exceeds escalation of care threshold. The dose can be repeated in 12 hours. (Aggregate Evidence Quality Grade C, Option)". However, they state that "The effectiveness of IVIG to prevent the need for an exchange transfusion is unclear."

• The EMA summary of product characteristics (SPC) for Kiovig 10% does not provide such an indication, but it IS indicated for children 0-18 years of age, which includes neonates (no specific reference to premature neonates, however). In addition, the Paediatric Population subsection under 4.2 Posology states explicitly that "The posology in children and adolescents (0-18 years) is not different to that of adults as the posology for each indication is given by body weight and adjusted to the clinical outcome of the above mentioned conditions."

• For neonatal-specific recommendations for IVIG therapy you may consult the Australasian Neonatal Medicines Formulary (ANMF) monograph for intravenous immunoglobulins, but note that they refer to the product Privigen and not Kiovig, so make sure you note the differences in formulation, rate of administration and other relevant aspects (in our NICU we use Privigen too, in the rare instances we need IVIG therapy).

Hope this helps!

Thank you so much, I will follow your advice.

Hello! I have little to add to Dotans excellent post above, just how we do this - we rarely use immunoglobulines but sometimes opt for this, when there is a DAT-driven hemolytic hyperbili.

We typically give 1g/kg, and start the infusion at 0.3 ml/kg/hour, doubling the infusion rate every half hour up to a max of 4.8 ml/kg/h. So, we end up with a total infusion time of about 3.5 hours.

I attach the XLS-sheet we use , I am sure you can translate with an AI-engine or so

Privigeninfusionsschema-4.xlsx