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Prenatal and postnatal prophylaxis of infections in preterm neonates
1Department of Clinical Immunology, Zurich, Switzerland.
Insights
Intravenous immunoglobulin (IVIG) therapy significantly increased serum IgG levels in preterm neonates, reducing septicemia mortality from 44% to 8%. Long-term follow-up showed no adverse effects from this essential neonatal treatment.
Area of Science:
- Neonatal Medicine
- Immunology
- Pediatric Infectious Diseases
Background:
- Preterm neonates often have immature immune systems, increasing susceptibility to infections like septicemia.
- Low serum immunoglobulin G (IgG) levels in preterm infants contribute to their vulnerability to bacterial infections.
- Intravenous immunoglobulin (IVIG) therapy is a potential strategy to bolster humoral immunity in high-risk neonates.
Purpose of the Study:
- To evaluate the efficacy and safety of IVIG administration in preterm neonates.
- To assess the impact of IVIG on serum IgG levels and mortality rates in preterm infants with septicemia.
- To investigate the long-term safety and effects of neonatal IVIG treatment on immune status.
Main Methods:
- Administered IVIG (0.3-0.5 g/day for 6 days) to preterm neonates based on weight.
- Monitored serum IgG levels before and after IVIG treatment.
- Compared mortality rates in septicemic preterm infants receiving antibiotics with or without IVIG.
- Conducted clinical examinations and monitored vital signs for adverse reactions.
- Performed follow-up assessments at 2.5 years and analyzed liver enzymes and serum IgG levels at later time points.
Main Results:
- IVIG administration significantly increased serum IgG levels in preterm neonates to levels comparable to term infants.
- Mortality rate in preterm infants with septicemia decreased from 44% to 8% with combined IVIG and antibiotic therapy.
- IVIG was well-tolerated, with no significant adverse reactions observed during treatment or follow-up.
- Long-term follow-up at 2.5 years revealed no harmful effects of neonatal IVIG treatment.
- No differences in liver enzymes were found between IVIG-treated and untreated infants at 6 weeks post-treatment.
Conclusions:
- IVIG is a safe and effective treatment for increasing serum IgG levels in preterm neonates.
- IVIG significantly reduces mortality associated with septicemia in preterm infants.
- Neonatal IVIG therapy demonstrates a favorable long-term safety profile with no discernible adverse effects.
Abstract:
Administration of gamma-globulin for intravenous administration (IVIG) to preterm neonates (0.3 g/day in neonates below 1000 g; 0.5 g/day in neonates over 1000 g for 6 consecutive days) led to a significant rise in circulating serum IgG levels. After 6 days of IVIG administration, the IgG serum levels reached an average of 11 to 12 g/liter, values usually seen in normal term infants. The mortality rate of the preterm infants with septicemia decreased from 44% in the infants receiving only antibiotics to 8% in the infants treated by IVIG together with the same antibiotic. The IVIG preparation was well-tolerated by all newborns. Blood gas analysis, clinical examination, monitoring of respiration, pulse and body temperature revealed no untoward reactions attributable to IVIG. Follow-up at an average age of 2.5 years showed no evidence of harmful effects of IVIG treatment in the neonatal period. In a recently concluded study no differences in the levels of various liver enzymes in infants treated with IVIG and in untreated infants was found 6 weeks after administration of IVIG. In another group of preterm infants with perinatal infections who received IVIG after birth, the serum IgG levels were determined at 3 to 4 and 6 to 8 weeks of age. At 3 to 4 weeks no difference was found in the serum IgG levels in infants with or without recurrent infections. At 6 to 8 weeks the serum IgG levels were slightly decreased in infants with recurrent as compared to those without recurrent infections.(ABSTRACT TRUNCATED AT 250 WORDS)