Previous Siblings Did Not Have In Utero ICH (Fig. 51.1)

A. Begin IVIG at 1 g/kg/wk at 20 weeks. Some also advocate adding prednisone 0.5 mg/kg/d, or using the higher dose of IVIG (2 g/kg/wk) (9); these two latter options were shown to be comparable in a RCT (8). Given the side effects of prednisone, we prefer to use IVIG only in these cases as initial therapy. One can consider starting at the higher dose (2 g/kg/w) if the initial platelet count of the affected neonate was <20,000/mL at birth.