Use of intravenously administered immune globulin to prevent nosocomial sepsis in low birth weight infants: Report of a pilot study

Clapp, D. Wade; Kliegman, Robert M.; Baley, Jill E.; Shenker, Nancy; Kyllonen, Kay; Fanaroff, Avroy A.; Berger, Melvin

doi:10.1016/s0022-3476(89)80753-x

Cited by 92 publications

(27 citation statements)

References 17 publications

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“…Reduced expression of FcRIII and FcRII may affect PMN function and the efficiency of IVIG infusion in the prevention (32,33) or treatment of bacterial infections in prematurely born neonates (34). At least part of the potential effectiveness of IVIG resides in its ability to opsonize bacteria and then serve as a ligand binding the bacteria to the PMN via FcR.…”

Section: Discussionmentioning

confidence: 99%

Cell-Surface Expression of Immunoglobulin G Receptors on the Polymorphonuclear Leukocytes and Monocytes of Extremely Premature Infants

Payne¹,

Frestedt²,

Hunkeler³

et al. 1993

Pediatr Res

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ABSTRACT. This study measured Fc gamma receptor GPI, glycosyl-phosphatidylinositol (FcR) expression on polymorphonuclear leukocytes IVIG, i.v. administered IgG (PMN) and monocytes from extremely premature infants.MCF, mean log channel fluorescence Flow cytometry was used to quantitate FcRIII [cluster of PMN, polymorphonuclear leukocyte differention (CD) 161, FcRII (CD32), FcRI (CD64), CD14, WBC, white blood cell count and CD67 proteins on the PMN surface. Sixty-four pre-NICU, neonatal intensive care unit mature infants with a mean gestational age 2 SD of 26 2 2 wk (birth weight = 847 f 217 g), 12 infants born at term (gestational age = 38 + 1 wk), and 37 adults were studied.

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Section: Discussionmentioning

confidence: 99%

Cell-Surface Expression of Immunoglobulin G Receptors on the Polymorphonuclear Leukocytes and Monocytes of Extremely Premature Infants

Payne¹,

Frestedt²,

Hunkeler³

et al. 1993

Pediatr Res

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“…The numbers indicated in Tables 1 and 2 for each study may differ from those reported in the original studies' conclusions because metaanalysis outcome criteria required blood culture-positive sepsis. The study by Clapp et al 14 reported results for a total of 200 patients, 115 of whom were randomly assigned to IVIG and placebo groups in a double-blind fashion. The additional 85 patients were not randomly assigned due to parental refusal.…”

Section: Resultsmentioning

confidence: 99%

“…The prophylactic effectiveness of IVIG using our outcome criteria individually and collectively for each of the 12 studies is shown in Figure 1. Five studies [12][13][14]17,22 demonstrated a statistically significant protective advantage for IVIG in preventing early-onset sepsis. In contrast, one study 30 showed a statistically higher sepsis rate for subjects who did receive IVIG.…”

Section: Ivig For Prevention Of Neonatal Sepsismentioning

confidence: 99%

“…These studies included populations ranging in number from 20 to 2416 newborns. The conclusions of the authors have ranged from definite or apparent reduction of infection, [12][13][14][15][16][17] to no or limited reduction (including the two largest studies), 18 -29 to a possible deleterious effect of IVIG. 30,31 At least four prospective, randomized studies published from 1986 to 1992 have evaluated the effect of IVIG in addition to standard therapies for the treatment of neonatal sepsis.…”

mentioning

confidence: 99%

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Meta-analyses of the Effectiveness of Intravenous Immune Globulin for Prevention and Treatment of Neonatal Sepsis

Jenson

Pollock

1997

Pediatrics

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ABSTRACT. Objective. To determine the effectiveness of intravenous immune globulin (IVIG) in the prevention and treatment of neonatal sepsis.Design. All published studies of IVIG for the prevention or treatment of neonatal sepsis were reviewed. Peerreviewed, prospective, randomized trials with high merit were analyzed by two meta-analyses. The effect of prophylactic IVIG was evaluated by comparison of the numbers of cases of sepsis (bacteremia in the presence of systemic manifestations of sepsis), and of therapeutic IVIG by comparison of the numbers of deaths resulting from early-onset sepsis.Results. Meta-analysis of 4933 evaluable newborns in 12 studies of IVIG prophylaxis showed a statistically significant negative association with the incidence of sepsis in premature low birth weight newborns given IVIG shortly after birth (P ‫؍‬ .0193, two-sided). The heterogeneity across these studies precluded estimation of a common odds ratio. Meta-analysis of 110 evaluable cases of neonatal sepsis in three studies of IVIG treatment of neonatal sepsis showed a significant decrease in the mortality rate for neonates with sepsis given IVIG (P ‫؍‬ .007, two-sided). The common odds ratio was .173 (95% confidence interval ‫؍‬ .031 to .735).Conclusions. Using conservative and objective outcome rating criteria, the addition of IVIG to standard therapies is of minimal but demonstrable benefit in preventing sepsis when administered prophylactically to premature low birth weight newborns, and of unequivocal benefit in preventing death when administered therapeutically for early-onset neonatal sepsis. The likelihood of newborns with sepsis living past the neonatal period was improved nearly sixfold when IVIG was administered in addition to standard therapies. Pediatrics 1997;99(2). URL: http://www.pediatrics.org/cgi/content/ full/99/2/e2; neonatal sepsis, immune globulin.ABBREVIATIONS. IgG, immunoglobulin G; IVIG, intravenous immune globulin; OR, odds ratio; CI, confidence interval.Humoral immunity of the human newborn is provided primarily by maternal immunoglobulin G (IgG) transferred transplacentally beginning at 8 to 10 weeks of gestation and accelerating during the last trimester. The lack of opsonic antibody is an important risk factor for susceptibility of newborns to infections caused by many bacteria with polysaccharide capsules (eg, group B Streptococcus, Escherichia coli, Haemophilus influenzae type b, Streptococcus pneumoniae) that cause serious bacterial infections in newborns.1,2 Premature infants, compared to full-term infants, have lower levels of IgG at birth that further decreases during the first few weeks of life. The relative deficiency of humoral immunity in premature newborns may contribute to the inverse correlation of birth weight and rate of neonatal sepsis, with an 86-fold increased rate of sepsis in newborns of birth weight 600 to 999 grams compared to newborns of birth weight of more than 2500 grams.

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“…Preterm infants born before 28 weeks' gestation are at greater risk of invasive bacterial infections [12], but current studies indicate that late preterm infants also have a significantly higher rate of complications of prematurity and experience more difficulties with feeding, hypoglycemia, jaundice, temperature instability, apnea, and respiratory distress [13].…”

Section: -Informações Do Pacientementioning

confidence: 99%

Avaliação da resposta imune após estimulação de monócitos via Toll-Like Receptor 2 (TLR-2) em recém-nascidos a termo e pré-termo

Faria¹

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Aos meus pais e irmãDedico esta tese aos meus pais Arly e Marlene e à minha irmã Carolina que sempre me apoiaram e me incentivaram a buscar a realização dos meus sonhos, mesmo que fosse necessário ficarmos distantes e que minha ausência perduraria por um longo período. Obrigada por estarem sempre ao meu lado, pelo carinho e amor absoluto.Agradecimento especial À minha orientadora Dra. Patricia Palmeira por mais essa oportunidade oferecida, pela confiança depositada e, principalmente, agradeço pela disponibilidade, pela atenção, pelas conversas, pelos conselhos, por poder contar sempre com o seu apoio. Todos esses anos trabalhando juntas contribuíram decisivamente para o meu crescimento como profissional e como pessoa. AgradecimentosAgradeço, primeiramente, a Deus por me guiar todos os dias, por me dar forças para superar todas as dificuldades e me manter forte para seguir em frente.Este espaço é dedicado a todos aqueles que de forma direta ou indireta contribuíram para a realização deste trabalho. Não sendo possível citar a todos, há, no entanto, alguns a quem não posso deixar de manifestar o meu apreço e agradecimento sincero: À Profa. Dra. Magda Carneiro-Sampaio por ter disponibilizado seu Laboratório permitindo, assim, a realização deste trabalho. Às colegas do Laboratório LIM-36:À Ana Lucia Silveira Lessa, pelo companheirismo e pela ajuda em todos esses anos dedicados ao nosso trabalho. À Camila Rennó, pelo companheirismo, pela sua disponibilidade e contribuição durante o desenvolvimento do trabalho e, principalmente, pela paciência dedicada a mim nos vários momentos de tensão. À Letícia Zicari Boneder, pela alegre convivência e companheirismo e que, mesmo permanecendo por pouco tempo em nosso laboratório, contribuiu para o desenvolvimento deste trabalho.À Laila Lima, pela dedicação e disponibilidade em todos os momentos, agradeço muito por toda a ajuda concedida.

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Use of intravenously administered immune globulin to prevent nosocomial sepsis in low birth weight infants: Report of a pilot study

Cited by 92 publications

References 17 publications

Cell-Surface Expression of Immunoglobulin G Receptors on the Polymorphonuclear Leukocytes and Monocytes of Extremely Premature Infants

Cell-Surface Expression of Immunoglobulin G Receptors on the Polymorphonuclear Leukocytes and Monocytes of Extremely Premature Infants

Meta-analyses of the Effectiveness of Intravenous Immune Globulin for Prevention and Treatment of Neonatal Sepsis

Avaliação da resposta imune após estimulação de monócitos via Toll-Like Receptor 2 (TLR-2) em recém-nascidos a termo e pré-termo

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