Intravenous Immunoglobulin in the Treatment of Salmonella Typhimurium Infections in Preterm Neonates

Abstract

The purpose of this study was to determine the role of intravenous immunoglobulin (IVIG) administration in preterm neonates with S. typhimurium infection. A randomized trial of 47 preterm neonates with intestinal or extraintestinal S. typhimurium infection was performed. Neonates were randomly divided into two groups: 22 neonates were only given cefoperazone (group 1); 25 neonates were given cefoperazone plus IVIG (group 2). IVIG was given at a dose of 500 mg/kg on days 1, 2, 3, and 8 after entry into the study. Following treatment, bacteremia, complications, mortality rate, recovery time, and duration of antimicrobial therapy were evaluated in two groups. Bacteremia was found in 31.4% in group 1 and 8% in group 2 (P < .05); complications developed in 81.8% in group 1 and 16% in group 2 (P < 0.01); mortality was 40.9% in group 1 and 12% in group 2 (P < .05). Recovery took 15 days in group 1 and 8 days in group 2 (P < .01). The duration of antimicrobial therapy was 20 days in group 1 and 14 days in group 2 (P < .01). We conclude that IVIG treatment in combination with antibiotics in preterm neonates with S. typhimurium infection reduces the complications, mortality rate, and duration of therapy.

Adjuvant use of intravenous immunoglobulin in the treatment of neonatal sepsis: a systematic review with a meta-analysis

“…Foram encontrados 53 estudos, dos quais nove [13][14][15][16][17][18][19][20][21] foram selecionados para leitura do texto completo. Outros dois estudos foram selecionados para leitura do texto completo através de busca manual 22,23 .…”

“…Dentre os 11 estudos selecionados primariamente, quatro artigos não foram incluídos na análise dos dados: um estudo 18 não tinha seu texto integral disponível na sede da Biblioteca Regional de Medicina (BIREME), e três foram excluídos [19][20][21] As características principais dos sete estudos incluídos estão descritas nas Tabelas 1 e 2.…”

“…A inclusão desses três estudos (Erdem et al 18 , Samatha et al 24 e Sidiropoulos et al 25 ), bem como dos estudos excluídos por Jadad et al < 3 [19][20][21] , diminuiria a qualidade metodológica desta revisão, já que os autores se preocuparam em avaliar apenas estudos com boa qualidade metodológica e que, provavelmente, não alterariam o resultado global, por se tratarem de estudos de baixo peso. Além disso, esta revisão inclui o estudo de Brocklehurst et al 13 , publicado em setembro de 2011, que possui uma amostra muito maior e com qualidade metodológica superior aos estudos publicados e analisados anteriormente, ressaltando a qualidade e validade desta revisão.…”

Immunoglobulins in the Prevention and Treatment of Neonatal Sepsis

“…The test of heterogeneity was not significant. One study (38) reported a significant reduction in mortality, three studies reported a positive trend (31,33,42), and two studies (34,40) showed no effect. One trial (36) showed a duplication of mortality; one neonate died in the control group and two in the treatment group.…”

“…The study of El Nawawy (32) reported a significant reduction of mortality, the other four a positive trend (35,37,39,41). Polyvalent immunoglobulin preparations containing only IgG were evaluated in seven trials (31,33,34,36,38,40,42) involving 358 patients. The cumulative dose of IgG was 0.5-3 g/kg birth weight.…”