Abstract

Research Article

Efficacy of intravenous immunoglobulins in the prophylaxis of neonatal sepsis

Sharif S*, Bloomer C, Al Assaf N and Khan R

Published: 14 April, 2021 | Volume 4 - Issue 1 | Pages: 038-041

Despite critical care advances, robust antibiotic therapy and improved strategies in early detection and prevention of infection, the incidence of morbidity and mortality from neonatal sepsis worldwide in preterm and low birth weight neonates remains overwhelmingly high. Neonatal sepsis is characterised by a clinical syndrome of systemic signs of infection and bloodstream bacteraemia in newborns within the first months of life. The risk of sepsis in neonates is inversely proportional to gestational age and birth weight due to deficiency in humoral immunity and the need for more invasive supportive neonatal intensive care unit interventions. Adverse effects such as necrotising enterocolitis associated with antimicrobial therapy are serious enough to warrant exploration of alternative therapeutic strategies. Immunoglobulin replacement therapy offers hope of enhancing immune competence and reducing infection rates in vulnerable populations. It is evident from the relevant studies to date that the benefits offered by intravenous immunoglobulin prophylaxis may not be significant enough for routine hospital implementation. Further research to better understand the mechanisms underlying immunodeficiency will lead to the realisation of alternative therapeutic and prophylactic interventions.

Read Full Article HTML DOI: 10.29328/journal.japch.1001029 Cite this Article Read Full Article PDF

Keywords:

Neonatal sepsis; Neonatal infection; Intravenous immunoglobulins; Low birth weight infant; Premature infant

References

  1. Capasso L, Borrelli A, Ferrara T, Coppola C, Cerullo J, et al. Immunoglobulins in neonatal sepsis: has the final word been said? Early Human Development. 2014; 90: S47-S49.
  2. Simonsen K, Anderson-Berry A, Delair S, Davies H. Early-Onset Neonatal Sepsis. Clin Microb Rev. 2014; 27: 21-47. PubMed: https://pubmed.ncbi.nlm.nih.gov/24396135/
  3. McGuire W, Clerihew L, Fowlie P. Infection in the preterm infant. BMJ. 2004; 329: 1277-1280. PubMed: https://pubmed.ncbi.nlm.nih.gov/15564261/
  4. Clapp D, Kliegman R, Baley J, Shenker N, Kyllonen K, et al. Use of intravenously administered immune globulin to prevent nosocomial sepsis in low birth weight infants: Report of a pilot study. J Pediatr.1989; 115: 973-978. PubMed: https://pubmed.ncbi.nlm.nih.gov/2585237/
  5. Bussel J. Intravenous Gammaglobulin in the Prophylaxis of Late Sepsis in Very-Low-Birth-Weight Infants: Preliminary Results of a Randomized, Double-Blind, Placebo-Controlled Trial. Clin Infect Dis. 1990; S457-S462. PubMed: https://pubmed.ncbi.nlm.nih.gov/2194270/
  6. Ohlsson A, Lacy JB. Intravenous immunoglobulin for preventing infection in preterm and/or low birth weight infants. Cochrane Database of Syst Rev. 2013.
  7. Raymond S, Stortz J, Mira J, Larson S, Wynn J, et al. Immunological Defects in Neonatal Sepsis and Potential Therapeutic Approaches. Front Pediatr. 2017; 5: 14. PubMed: https://pubmed.ncbi.nlm.nih.gov/28224121/
  8. Haque K, Zaidi M, Haque S, Bahakim H, El-Hazmi M, et al. Intravenous immunoglobulin for prevention of sepsis in preterm and low birth weight infants. Pediatr Infect Dis J. 1986; 5: 622-625. PubMed: https://pubmed.ncbi.nlm.nih.gov/3099267/
  9. Chirico G, Rondini G, Plebani A, Chiara A, Massa M, et al. Intravenous gammaglobulin therapy for prophylaxis of infection in high-risk neonates. J Pediatr. 1987; 110: 437-442. PubMed: https://pubmed.ncbi.nlm.nih.gov/3102711/
  10. Stabile A, Miceli Sopo S, Romanelli V, Pastore M, Pesaresi M. Intravenous immunoglobulin for prophylaxis of neonatal sepsis in premature infants. Arch Dis Child. 1988; 63: 441-443. PubMed: https://pubmed.ncbi.nlm.nih.gov/3284483/
  11. Conway S, Ng P, Howel D, Maclain B, Gooi H. Prophylactic Intravenous Immunoglobulin in Pre-Term Infants: A Controlled Trial. Vox Sanguinis. 1990; 59: 6-11. PubMed: https://pubmed.ncbi.nlm.nih.gov/2204192/
  12. Ratriswadi V, Srisuwaporn T, Puapondh Y. Intravenous immunoglobulin prophylaxis for infection in scientific birth-weight infants. J Med Assoc Thai. 1991; 74: 4-18. PubMed: https://pubmed.ncbi.nlm.nih.gov/1902866/
  13. Baker C, Melish M, Hall R, Casto D, Pharm D, et al. Intravenous Immune Globulin for the Prevention of nosocomial Infection in Low-Birth-Weight Neonates. N Engl J Med. 1992; 327: 213-219. PubMed: https://pubmed.ncbi.nlm.nih.gov/1614462/
  14. Fanaroff A, Korones S, Wright L. A controlled trial of intravenous immune globulin to reduce nosocomial infections in very-low-birth-weight infant. J Pediatr. 1994; 125: 840-841.
  15. Weisman L, Stoll B, Kueser T, Rubio T, Frank C, et al. Intravenous immune globulin prophylaxis of late-onset sepsis in premature neonates. J Pediatr. 1994; 125: 922-930.
  16. Lacy J, Ohlsson A. Administration of intravenous immunoglobulins for prophylaxis or treatment of infection in preterm infants: meta-analyses. Arch Dis Child Fetal Neonatal Ed. 1995; 72: F151-F155. PubMed: https://pubmed.ncbi.nlm.nih.gov/7796228/
  17. Jenson H, Pollock B. Meta-analyses of the Effectiveness of Intravenous Immune Globulin for Prevention and Treatment of Neonatal Sepsis. Pediatrics. 1997; 99: e2-e2. PubMed: https://pubmed.ncbi.nlm.nih.gov/9099759/
  18. Sandberg K, Fasth A, Berger A, Eibl M, Isacson K, et al. Preterm infants with low immunoglobulin G levels have increased risk of neonatal sepsis but do not benefit from prophylactic immunoglobulin G. J Pediatr. 2000; 137: 623-628. PubMed: https://pubmed.ncbi.nlm.nih.gov/11060526/
  19. Hill H. Additional confirmation of the lack of effect of intravenous immunoglobulin in the prevention of neonatal infection. J Pediatr. 2000; 137: 595-597. PubMed: https://pubmed.ncbi.nlm.nih.gov/11060519/
  20. Hemming V. Use of Intravenous Immunoglobulins for Prophylaxis or Treatment of Infectious Diseases. Clin Vaccine Immunol. 2001; 8: 859-863. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC96160/
  21. Goodarzi R, Dustkhah S, Khamesan B, Saadat S. Effect of intravenous immunoglobulin in prevention of preterm neonatal sepsis: a clinical trial study. Acta Healthmedica. 2017; 2: 211-216. PubMed: https://pubmed.ncbi.nlm.nih.gov/9523399/
  22. Bruton OC. Agammaglobulinemia. Paediatrics. 1952; 9: 722-728. PubMed: https://pubmed.ncbi.nlm.nih.gov/14929630/

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More