Are IgM-enriched immunoglobulins an effective adjuvant in septic VLBW infants?

Letizia Capasso, Angela Carla Borrelli, Claudia Parrella, Silvia Lama, Teresa Ferrara, Clara Coppola, Maria Rosaria Catania, Vita Dora Iula, Francesco Raimondi, Letizia Capasso, Angela Carla Borrelli, Claudia Parrella, Silvia Lama, Teresa Ferrara, Clara Coppola, Maria Rosaria Catania, Vita Dora Iula, Francesco Raimondi

Abstract

Aim: To investigate the effectiveness of IgM-enriched immunoglobulins (IgM-eIVIG) in reducing short-term mortality of neonates with proven late-onset sepsis.

Methods: All VLBW infants from January 2008 to December 2012 with positive blood culture beyond 72 hours of life were enrolled in a retrospective cohort study. Newborns born after June 2010 were treated with IgM-eIVIG, 250 mg/kg/day iv for three days in addition to standard antibiotic regimen and compared to an historical cohort born before June 2010, receiving antimicrobial regimen alone. Short-term mortality (i.e. death within 7 and 21 days from treatment) was the primary outcome. Secondary outcomes were: total mortality, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia at discharge.

Results: 79 neonates (40 cases) were enrolled. No difference in birth weight, gestational age or SNAP II score (disease severity score) were found. Significantly reduced short-term mortality was found in treated infants (22% vs 46%; p = 0.005) considering all microbial aetiologies and the subgroup affected by Candida spp. Secondary outcomes were not different between groups.

Conclusion: This hypothesis-generator study shows that IgM-eIVIG is an effective adjuvant therapy in VLBW infants with proven sepsis. Randomized controlled trials are warranted to confirm this pilot observation.

Figures

Figure 1
Figure 1
Main pathogens isolated from blood cultures.

References

    1. Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev. 2004;17:638–680. doi: 10.1128/CMR.17.3.638-680.2004.
    1. Raimondi F, Ferrara T, Maffucci R, Milite P, Del Buono D, Santoro P, Grimaldi LC. Neonatal sepsis: a difficult diagnostic challenge. Clin Biochem. 2011;44(7):463–464. doi: 10.1016/j.clinbiochem.2011.03.030.
    1. Wilson CB. Immunologic basis for increased susceptibility of the neonate to infection. J Pediatr. 1986;108:1–12. doi: 10.1016/S0022-3476(86)80761-2.
    1. Tarnow-Mordi W, Isaacs D, Dutta S. Adjunctive immunologic interventions in neonatal sepsis. Clin Perinatol. 2010;37:481–499. doi: 10.1016/j.clp.2009.12.002.
    1. The INIS Collaborative Group. Treatment of neonatal sepsis with intravenous immune globulin. N Engl Med. 2011;365:1201.
    1. Ohlsson A, Lacy JB. Intravenous immunoglobulins for suspected or proven infection in neonate (review) The Cochrane Library. 2013;7:CD001239.
    1. Schedel I, Dreikhausen U, Nentwig B. et al.Treatment of gram-negative septic shock with an immunoglobulin preparation: a prospective, randomized clinical trial. Crit care Med. 1991;19:1004–1013. doi: 10.1097/00003246-199108000-00005.
    1. Rodríguez A, Rello J, Neira J. et al.Effects of high-dose of intravenous immunoglobulin and antibiotics on survival for severe sepsis undergoing surgery. Shock. 2005;23:298–304. doi: 10.1097/01.shk.0000157302.69125.f8.
    1. Vermont Oxford Network. Vermont Oxford Network Database Manual of Operations part 2: data definitions, data forms and submission timeline for infants born in 2011. Release 15.1. Published January 2011. Available on .
    1. Richardson DK, Concoran JD, Escobar GJ. et al.SNAPII and SNAPPE II: simplified newborn illness severity and mortality risk scores. J Pediatrics. 2001;138:92–100. doi: 10.1067/mpd.2001.109608.
    1. Sundaram V, Dutta S, Ahluwalia J, Narag A. et al.Score for Neonatal Acute Physiology II predicts mortality and persistent organ disfunction in neonates with severe septicemia. Indian Pediatr. 2009;46:775–780.
    1. Stehr SN, Knels L, Weissflog C. et al.Effects of IGM-enriched solution on polymorphonuclear neutrophil function, bacterial clearance, and lung histology in endotoxemia. Shock. 2008;29:167–172.
    1. Haque KN, Zaidi MH, Bahakim H. IgM-enriched intravenous immunoglobulin therapy in neonatal sepsis. Am J Dis Child. 1988;142:1293–1296.
    1. Haque KN, Remo C, Bahakim H. Comparison of two types of intravenous immunoglobulins in treatment of neonatal sepsis. Clin Exp Immunol. 1995;101:328–333.
    1. Erdem G, Yurdakok M, Tekinalp G. et al.The use of IgM-enriched intravenous immunoglobulin for the treatment of neonatal sepsis in preterm infants. Turk L Pediatr. 1993;35:277.
    1. Shoham S, Levitz SM. The immuno response to fungal infections. Br J Haematol. 2005;129:569. doi: 10.1111/j.1365-2141.2005.05397.x.

Source: PubMed

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