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Immunoglobulins and IgG subclasses in children following severe head injury
N W Wilson1, Y P Wu, B Peterson
1Department of Pediatrics, West Virginia University, Morgantown 26506.
Insights
Severe head trauma in children causes a rapid increase in IgM (immunoglobulin M) within seven days. Unlike burn patients, these children do not experience persistent immunoglobulin deficits after injury.
Area of Science:
- Immunology
- Pediatric Traumatology
- Critical Care Medicine
Background:
- Severe blunt head trauma can significantly impact a child's immune system.
- Understanding immunoglobulin dynamics is crucial for managing pediatric trauma patients.
Purpose of the Study:
- To investigate changes in immunoglobulin production following severe blunt head trauma in pediatric patients.
- To compare immunoglobulin profiles in head-injured children to normal age-specific levels.
Main Methods:
- Serum samples from 10 children with severe head injuries were analyzed for IgG, IgM, IgA, IgE, and IgG subclasses.
- Measurements were taken on days 1, 7, 14, and 21 post-injury.
- Levels were compared to age-specific normal controls.
Main Results:
- Immunoglobulin M (IgM) levels surged dramatically, averaging 383% of normal by day 7 (p < 0.01).
- While 50% of patients showed low IgG (immunoglobulin G) initially, levels normalized by day 21.
- Elevated IgE (immunoglobulin E) was observed in 3 patients; no significant difference in IgM between infected and non-infected patients.
Conclusions:
- Severe pediatric head trauma triggers a rapid IgM increase within a week.
- Unlike burn injuries, severe head trauma does not lead to persistent hypogammaglobulinemia in children.
- Immunoglobulin levels, particularly IgG and IgA, show a post-injury increase, though slower than IgM.
Objective:
To study immunoglobulin production after severe blunt head trauma in children.
Design:
Serum for IgG, IgM, IgA, IgE, and IgG subclasses were drawn from 10 children admitted with severe head injury (ISS 31.2, GCS 5.4) on day 1, 7, 14 and 21 after injury.
Results:
5 of the 10 patients developed infection between 7 and 14 days and 2 died of complications of pneumonia. On day 1, IgM levels averaged 95.6% of the mean of the age-specific normal controls. By day 7, IgM levels averaged 383% (p < 0.01). While all patients were within the age-specific normal range (+/- 2 SD) on day 1, 7 of 10 patients were above the normal range by day 7. There was no difference in IgM levels between infected and non-infected patients. Five patients were below the age-specific normal range for IgG on day 1, with 3 still low on day 7. By day 21, IgG levels averaged 141% of the mean of the age-specific normal controls. IgG subclasses followed a pattern similar to total IgG levels. Marked increases in IgE were seen in 3 patients.
Conclusions:
IgM levels increased dramatically in all patients within seven days of the injury. While 50% of these children had a deficit of IgG in the first week, total IgG and IgA levels increased after injury, but not as rapidly as IgM levels. Unlike pediatric burn patients, there is no persistent hypogammaglobulinemia following severe blunt trauma in children.