| Abstrakt: |
Plasma immunoglobulin concentrations of premature infants of birth weight less than 1500 g were measured longitudinally from birth to 10 months chronological age. Infants were divided into two groups based on gestational age (group I: 25–28 wk; group II: 29–32 wk). In the 1st wk of life, plasma IgG levels correlated with gestational age (r= 0.5, p< 0.001). At 3 months chronological age, the geometric mean plasma IgG levels were 60 mg/dl in group I and 104 mg/dl in group II infants. Most infants remained hypogammaglobulinemic at 6 months with seven of 11 infants in group I and 13 of 21 infants in group II having plasma IgG levels below 200 mg/dl. In the 1st wk of life, plasma IgM concentrations were 7.6 and 9.1 mg/dl in groups I and II, respectively. They rose to 41.8 and 34.7 by 8 to 10 months of life. Plasma IgA concentrations were comparable for groups I and II in the 1st wk of life (1.2 and 0.6 mg/dl, respectively), but at 1 month of age group I infants had a transient increase in IgA which was not seen in the group II infants (4.5 versus1.9 mg/dl, respectively, p< 0.02). This transient elevation in IgA did not correlate with type or route of feeding or amounts of transfused blood. Group I and group II infants had comparable rates of infections prior to discharge from the nursery (p= 0.27). After discharge, the 43 preterm infants followed until 10 months chronological age had a significantly higher incidence of infections than 41 term infants (p= 0.04). In addition, the preterm infants had more lower respiratory infections after discharge than term infants (14 versus2, p= 0.003), and were rehospitalized more often for infection (8 versus0, p= 0.01). Despite severe prolonged hypogammaglobulinemia, none of the preterm infants had bacteremic illness after discharge from the nursery. This study provides normal age-group immunoglobulin values for the first 10 months of life in very small premature infants. The lack of invasive bacterial infections in this small group of preterm infants after discharge from the nursery suggests that further studies will be necessary to determine whether the hypogammaglobulinemia places these very low birth weight infants at risk for serious infection. |
