• high dose intravenous immunoglobulin
• haemolytic disease of newborns

It was encouraging to read article of Gottstein et al,¹ on the use of high dose intravenous immunoglobulin (HDIVIG) in cases of haemolytic disease of newborns (HDN) with their conclusion showing the effectiveness of HDIVIG. I have the following observations to make with respect to implications on practice and future research.

Firstly, all the references mentioned were between three and ten years old.^2–6 These trials did not take into consideration the irradiance of the phototherapy used, although they did observe the number of exchange transfusions performed. Presently, a combination of blue and white fluorescent light double surface phototherapy, with effective higher irradiances of 20–40 uW/cm2/nm, can practically eliminate the need for exchange transfusion, even in severe cases of HDN. Irradiance of phototherapy can be increased further by decreasing the distance between the phototherapy unit and the patient, especially with an undersurface phototherapy unit, keeping thermal and nursing issues under consideration.

Secondly, the authors …