Intravenous immunoglobulin prophylaxis in neonates on artificial ventilation

Abstract

The efficacy of the prophylactic use of intravenous immunoglobulin (Ig) was   evaluated in a double-blind placebo-controlled trial of 21 pairs of ventilated  neonates weighing more than 1 500 g, Each infant received 0.4 g/kglday of intravenous Ig or a similar volume of placebo daily for 5 days. Criteria used to  assess the efficacy of intravenous 19 were the number of infections, the duration of ventilation therapy and time to clinical recovery. There were no significant   differences in the treated and placebo groups with regard to the frequency of positive  blood cultures 28.6% and 14.3%), endotracheal cultures (57.1% and 66.7%) and abnormal white cell counts (52.4% and 57.1 %). On entry to the stUdy there was no significant difference in IgG levels between the treated (974.5 mg/dl; SO 575.3) and placebo groups (818 mg/dl; SO 516.9). However, on day 6 the treated group had a mean level of 1 400.3 mg/dl (SO 426.7) versus 710.9 mg/dl (SO 377.4) in the placebo group (P < 0.05), Clinical improvement occurred within 3 days in both groups. Ventilatory support was required for 11.8 days (SO 8.3) in the treated and 11.8 days (SO 7.3) in the placebo group. Both groups required 3 • 4 antibiotic treatments over a period of 14 - 15 days. Two patients died in the treated and 4 in the placebo group, with 1 infant in each group developing bronchopulmonary dysplasia. The patients who recovered did so within 14 days. Analyses of subgroups of patients with different diagnoses revealed no differences except a trend  suggesting fewer infections in term babies treated with intravenous Ig. The  organisms cultured in the intravenous 19 groups were Pseudomonas, Klebsiella,
Escherichia coli and Staphylococcus and in the placebo group Pseudomonas,  Klebsiella and Enterobacter. The above has shown that, except for a trend in the older neonates, intravenous Ig is not of prophylactic benefit in ventilated n€Onates. Newer adjuncts in immunotherapy such as hyperimmune gammaglobulin or monoclonal antibodies may prove of greater value in the treatment of neonatal sepsis.