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Intravenous Immunoglobulin Use In Critically Ill Children
Camille Jutras1, Nancy Robitaille2, Michael Sauthier1
1Pediatric Critical Care Medicine Service, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, QC, Canada.
Summary
Intravenous immunoglobulin (IVIG) use in critically ill children is increasing, with many off-label uses. Further trials are needed to assess IVIG efficacy and safety in pediatric intensive care settings.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Pharmacology
Background:
- Rising demand for intravenous immunoglobulins (IVIG) presents challenges for blood suppliers.
- Indications for IVIG in critically ill children require clarification.
Purpose of the Study:
- To characterize the epidemiology of IVIG use in critically ill children.
- To identify common indications for IVIG in this patient population.
Main Methods:
- Single-center retrospective cohort study.
- Inclusion of patients aged 3 days to 18 years hospitalized in a pediatric intensive care unit.
- Data collected from January 1, 2013, to December 31, 2018.
Main Results:
- 172 patients received 342 IVIG infusions.
- Common indications included toxic shock syndrome, immunoglobulin replacement for chylothorax, bone marrow transplant prophylaxis, myocarditis, and post-solid organ transplant complications.
- 79% of IVIG infusions were for off-label indications per Health Canada guidelines.
Conclusions:
- Identified key indications for IVIG in critically ill children.
- High rate of off-label IVIG use highlights the need for evidence-based guidelines.
- Clinical trials are essential to evaluate IVIG efficacy and safety, considering costs and adverse events.
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