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New uses of intravenous immune globulin in newborn infants
1Baylor College of Medicine, Houston 77030.
Insights
Intravenous immune globulin (IVIG) may prevent infections in preterm infants under 1500g. This study found IVIG reduced systemic infections in this subgroup, showing promise for neonatal care.
Area of Science:
- Neonatalogy
- Immunology
- Pediatric Infectious Diseases
Background:
- Preterm infants exhibit hypogammaglobulinemia, increasing infection risk.
- Previous trials on intravenous immune globulin (IVIG) for preterm infants yielded inconclusive results regarding infection prevention.
Purpose of the Study:
- To evaluate the efficacy of IVIG in preventing systemic infections in preterm neonates weighing 500 to 1750 g.
Main Methods:
- A multicenter, randomized, double-blind, placebo-controlled trial was conducted.
- Participants received either IVIG (500 mg/kg) or placebo (5% albumin-normal saline) for 8 weeks.
- Infusions were administered periodically.
Main Results:
- Mortality rates were similar between IVIG and placebo groups (4%).
- IVIG significantly reduced the incidence of systemic infections, specifically in neonates weighing less than 1500 g.
- Bacterial infections, predominantly staphylococcal, accounted for over 80% of infections.
Conclusions:
- Periodic IVIG infusions show potential for reducing systemic infections in very low birth weight preterm infants (<1500 g).
- Further analysis of ongoing trials is needed to confirm standard IVIG use in preterm infants.
Abstract:
Preterm infants are hypogammaglobulinemic at birth, a condition that worsens during the first several weeks of life. It has been postulated that periodic infusions of intravenous immune globulin in preterm infants might prevent systemic infections after age 7 days, but clinical trials have been inconclusive. To test this hypothesis in neonates weighing 500 to 1750 g at birth, a multicenter, randomized, double-blind, placebo-controlled trial was initiated. Either intravenous immune globulin (500 mg/kg) (284 infants) or placebo (5% albumin-normal saline, 10 ml/kg) (293 infants) was infused periodically for 8 weeks. Infusions were well tolerated. Mortality (4%) was similar in both groups. However, the incidence of systemic infection was significantly reduced in the treatment group, but only in those weighing less than 1500 g. More than 80% of infections were bacterial; half were caused by staphylococci. Standard use of intravenous immune globulin in preterm infants looks promising but must await full analysis of data from this and another ongoing multicenter trial.