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Intravenous gamma globulin as adjunct therapy for severe group B streptococcal disease in the newborn
C A Friedman1, D F Wender, D M Temple
1Hinds General Hospital, Jackson, MS.
Insights
Intravenous gamma globulin (IVIg) may improve survival for newborns with severe Group B streptococcal (GBS) disease. This study found IVIg reduced mortality in high-risk infants with GBS infections.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Immunology
Background:
- Group B streptococcal (GBS) disease is a major cause of newborn illness and death.
- Current treatments, including antibiotics, are not always sufficient for severe GBS infections.
- Previous research suggests prophylactic intravenous gamma globulin (IVIg) may benefit newborns.
Purpose of the Study:
- To evaluate the efficacy of IVIg as an adjunctive therapy for infants with severe GBS disease.
- To assess the impact of IVIg on mortality rates in high-risk newborns with GBS infections.
Main Methods:
- Eighty-four infants with GBS antigen detected via latex agglutination assay were identified.
- A subgroup of 24 infants with neutropenia and high GBS antigen titers were identified as highest risk.
- Mortality rates were compared between high-risk infants before and after IVIg treatment became available.
Main Results:
- Before IVIg, 58% of the highest-risk infants died.
- After IVIg treatment, mortality in the highest-risk group decreased to 17% (p < 0.01).
- Recovery time from neutropenia was similar (2-4 days) in surviving infants, regardless of IVIg treatment.
Conclusions:
- IVIg may offer a beneficial effect as an adjunct therapy for severe GBS disease in newborns.
- IVIg shows promise in reducing mortality for high-risk infants with GBS infections.
- Further research is warranted to confirm the role of IVIg in managing severe GBS disease.
Abstract:
Group B streptococcal (GBS) disease remains a significant cause of morbidity and mortality among newborns despite aggressive antibiotic and supportive therapy. Recent success with the prophylactic use of intravenous gamma globulin (IVIg) in newborns suggests that use of IVIg may be an additional therapy for infants with severe GBS disease. Eighty-four infants with GBS antigen in serum, urine, and in some cases spinal fluid were identified by a rapid latex agglutination assay. Twenty-four of these infants had both neutropenia and serum GBS antigen titers of 1:10 or greater and had the highest risk of dying from their infection. Before the availability of IVIg, seven of the first 12 of these infants identified with the highest risk factors died (58%). Twelve additional patients with these highest risk factors have been treated with IVIg. Two of these 12 died (17%), p less than 0.01 when compared with the previous highest risk group. In surviving patients in both IVIg-treated and non-IVIg-treated groups, the time for recovery from neutropenia was 2 to 4 days. Our study suggests a possible beneficial effect of IVIg as adjunct therapy in severe GBS disease.