Intravenous immune globulin prophylaxis of late-onset sepsis in premature neonates

Autor: Charles T. Hankins, Leonard E. Weisman, Howard S. Heiman, K.N. Siva Subramanian, Thomas Rubio, David F. Cruess, C. Gilbert Frank, Thomas J. Kueser, Barbara J. Stoll, Gerald W. Fischer, Val G. Hemming
Rok vydání: 1994
Předmět:
Zdroj: The Journal of pediatrics. 125(6 Pt 1)
ISSN: 0022-3476
Popis: To determine whether a single dose of intravenously administered immune globulin (IVIG) decreases late-onset sepsis in premature infants, we prospectively entered 753 neonates with birth weight 500 to 2000 gm, gestationor = 34 weeks, and ageor = 12 hours into a multicenter, double-blind, controlled trial. Infants were randomly selected to receive a single intravenous infusion, 10 ml/kg, of either IVIG (500 mg/kg) or albumin (5 mg/kg) and were observed for 8 weeks for infection. Maternal and neonatal risk factors for infection did not differ between groups. Although serum IgG values before infusion were related to gestation (R = 0.62), the change in serum IgG or half-life of IgG after IVIG infusion was not (Ror = 0.09). The serum IgG concentration was increased (p0.05) in IVIG-treated patients for 8 weeks. There were 88 episodes of late-onset sepsis in 79 neonates (10.5%). Causative organisms included the following: Staphylococcus epidermidis (37 episodes), Enterococcus (9), Staphylococcus aureus (7), Candida (6), Escherichia coli (6), and multiple organisms (11). Sepsis, death, and death as a result of infection were unaffected by treatment. We conclude that a single infusion of IVIG, 500 mg/kg, shortly after birth was not effective prophylaxis for late-onset infection in premature neonates. Future studies of late-onset sepsis prophylaxis should consider IVIG with known pathogen-specific antibody concentrations against organisms causing these infections, in particular S. epidermidis.
Databáze: OpenAIRE