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Prevention of necrotizing enterocolitis in extremely low birth weight infants by IgG feeding?
D Richter1, P Bartmann, F Pohlandt
1Department of Paediatrics, Division of Neonatology and Paediatric Critical Care, Univerity of Ulm, Germany.
Insights
Oral immunoglobulin therapy did not prevent necrotizing enterocolitis (NEC) in extremely low birth weight (ELBW) infants. This study found no significant difference in NEC rates between infants receiving oral IgG and those who did not.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Immunology
Background:
- Necrotizing enterocolitis (NEC) is a serious condition affecting preterm infants.
- Oral immunoglobulin prophylaxis has been investigated as a preventative measure for NEC.
- Extremely low birth weight (ELBW) infants are particularly vulnerable to NEC.
Purpose of the Study:
- To evaluate the efficacy of oral immunoglobulin G (IgG) prophylaxis in preventing NEC in ELBW infants.
- To compare NEC incidence in ELBW infants who received oral IgG with a historical control group.
Main Methods:
- A historical cohort study design was employed.
- Two cohorts of ELBW infants were compared: a control group (no oral IgG) and an intervention group (oral human IgG).
- Infants were treated in a level III intensive care nursery, with NEC diagnosis based on the modified Bell classification.
Main Results:
- NEC (stage 2a or higher) occurred in 10.7% of the control group (n=84) and 8% of the oral IgG group (n=137).
- The difference in NEC incidence between the two groups was not statistically significant (P = 0.63).
- Gestational age and birth weight medians were similar between cohorts.
Conclusions:
- Oral IgG prophylaxis did not demonstrate a protective effect against NEC in ELBW infants in this study.
- Current evidence does not support the routine use of oral human IgG for NEC prevention in preterm infants.
Unlabelled:
Oral immunoglobulin has been described as preventing necrotizing enterocolitis(NEC) in preterm infants. To prevent NEC in extremely low birth weight infants (ELBW), we have carried out oral IgG prophylaxis since April 1991. The efficacy of this prophylaxis was examined in a study comparing historical cohorts. ELBW infants delivered in the Department of Obstetrics and Gynaecology of the University of Ulm and treated until day 28 in the level III intensive care nursery, Division of Neonatology, University of Ulm were included. Cohort 1, born between 1.1.1988 and 31.3.1991, received no oral IgG and served as a control [n = 84, gestational age: median 26 weeks, range 24-34; birth weight: 811 g, 490-990], cohort 2, born between 1.4.1991 and 31.12.1995 [n= 137, gestational age: 26 weeks, 22-32; birth weight: 760 g, 362-995], received 6 x 100 mg/kg human IgG (Beriglobin) orally on days 1-28. NEC, stage 2a and higher according to the modified classification of Bell, was observed in 9 of 84 (10.7%) infants of cohort 1 and in 11 of 137 (8%) infants of cohort 2 until day 28. The difference did not reach statistical significance (P = 0.63 Fisher's exact test).
Conclusion:
In this historical cohort study, ELBW infants were not protected against NEC by oral IgG. The present published evidence does not allow recommendation of oral human IgG administration in preterm infants as a prophylactic measure against NEC.