4CPS-130 Use of non-specific immunoglobulins in burned paediatric patients: validation of the protocol of a tertiary hospital

Abstract

BackgroundSerious burns produce plasma extravasation which develops an important loss of immunoglobulins (Ig). In patients with a burned surface area (BSA) >15% IgG plasmatic levels decrease until 40 hours’ post-burn.PurposeTo evaluate the use of non-specific Ig in burned paediatric patients based on the current protocol of the hospital.Material and methodsRetrospective observational study, which includes all paediatric patients with ≥15% BSA hospitalised between August 2012 and July 2017.Biodemographic data were registered as: (sex, age, weight), burn data (BSA) and Ig administration data (plasmatic levels, dose and number of administrations).The existing protocol about the use of Ig in burned paediatric patients (BSA ≥15%) was analysed. It recommends the determination of IgG 24 to 48 hours’ post-burn and the infusion of non-specific Ig (400 mg/kg) if patients have below-normal levels.ResultsThirty-one patients (12 females) with a median age of 2 years (8 m – 15 y) and a weight of 13 kg (7.5–67 kg) were enrolled in the study. The median BSA was 20% (15%–55%).Eighteen patients (58%) accomplished all the recommendations specified in the protocol.Determination of IgG levels was made in 26 patients (83.9%). Eighteen (69.2%) had below-normal levels and a median BSA of 23.5% (15–55). In the subgroup of patients with BSA ≥20% (20–55) the determination was done in the 94% (15/16) and 14 (93%) who had below-normal levels.Non-specific Ig was administered in 61% (19) of the patients at a dose of 400 mg/kg. No IgG determination was repeated after the first infusion in six patients (31.6%). Seven patients with a median BSA of 46% (16–55) needed more than one Ig infusion.ConclusionAll patients received the dose of Ig indicated in the protocol (400 mg/kg).In patients with BSA>20%, determination of plasmatic levels is essential because it was detected that more than 90% of the patients had below–normal levels of IgG.No IgG determination after the first infusion was repeated in more than 30% of the patients, therefore a proposal to improve the protocol is the need to repeat IgG determination in all the patients who have received an infusion to corroborate the achievement of normal IgG levels.References and/or AcknowledgementsThanks to all authorsNo conflict of interest