Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration

Yen, Meng-Hua; Huang, Yhu Chering; Chen, Min Chi; Liu, Ching Chuan; Chiu, Nan Chang; Lien, Reyin; Chang, Luan Yin; Chiu, Cheng Hsun; Tsao, Kuo Chien; Lin, Tzou Yien

doi:10.1016/j.jcv.2015.01.013

Cited by 61 publications

(29 citation statements)

References 24 publications

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“…There are currently no specific therapies for EV infections with a proven benefit. For infants and children with severe CNS infections, there are limited data suggesting IVIG may be beneficial 26. The only randomised clinical trial of IVIG for the treatment of EV infections in neonates demonstrated some very minor improvements in clinical and laboratory parameters in those infants who received IVIG; however, only 16 infants were included in the trial 27.…”

Section: What Is the Treatment For Ev Meningitis/encephalitis?mentioning

confidence: 99%

Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

Drysdale

Kelly

2016

Arch Dis Child Educ Pract Ed

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Enterovirus (EV) is the most common cause of aseptic meningitis and has a benign course, unlike EV encephalitis, which can result in long-term neurological sequelae. There are no active treatments or prophylactic agents, and management is purely supportive. Obtaining an EV-positive cerebrospinal fluid result usually allows antimicrobial treatment to be stopped. This review will answer some of the common questions surrounding EV meningitis/encephalitis.

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Section: What Is the Treatment For Ev Meningitis/encephalitis?mentioning

confidence: 99%

Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

Drysdale

Kelly

2016

Arch Dis Child Educ Pract Ed

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“…Treatment of infants with IVIG may prevent brain viral infection from becoming fatal or severe sequelae [23]. Early administration of IVIG has been reported to improve fatal EV infections such as hepatitis with coagulopathy and thrombocytopenia or myocarditis [24]. Abzug et al [17] also demonstrated that neutralization of EVs using 750 mg/kg IVIG can change the course of encephalitis with rapid cessation of viremia and can improve the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Differences between Enterovirus and Human Parechovirus in Children and Infants

Rhie

2020

Ann Child Neurol

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Purpose: Enteroviruses (EVs) and human parechoviruses (HPeVs) are important pathogens that cause fever in young infants and meningitis in children and have similar clinical symptoms and characteristics. The aim of this study was to compare the clinical symptoms and characteristics of EV and HPeV infections in young children and infants. Methods: From June to August 2018, we obtained 50 cerebrospinal fluid (CSF) samples, of which 36 and 14 were EV-and HPeV-positive, respectively, as determined by film array methods. We then compared the clinical characteristics and laboratory values of patients with EV and HPeV infections. Results: HPeV patients had a lower age than EV patients, but had similar sex predominance and fever duration. Moreover, EV patients had a higher prevalence of headache and mannitol use than HPeV patients. The blood and CSF white blood cell counts were lower among HPeV patients even after adjusting for sex and age. Furthermore, both viruses were found to cause occasional transient white matter injuries in the brain. Conclusion: The clinical characteristics of HPeV and EV infections were found to be generally similar, but with a few noteworthy differences.

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“…However, a multicenter research report showed that therapy with IVIG had no effect on the outcomes of suspected or proven neonatal sepsis [ 16 ]. Despite those negative results in neonatal sepsis trials, the high dose of IVIG is still commonly used as immune regulation during severe preterm infection [ 17 – 19 ], and additional mechanisms need to be analyzed [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

High-dose of intravenous immunoglobulin modulates immune tolerance in premature infants

Fan

et al. 2018

BMC Pediatr

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BackgroundIntravenous immunoglobulin (IVIG) is commonly used to improve the immunomodulatory effects, although its regulatory effect on premature Treg cells is unclear. The purpose of this study is to study the effect of high dose of IVIG (HD-IVIG) on Treg cells expression and cytokine profile in premature birth.MethodsFifty-two premature infants were enrolled in this study and thirty-one premature infants who were suspected to have intrauterine infection received HD-IVIG (1–2 g/kg) at the first day of birth; the remaining 21 premature infants were assigned as the control group. The peripheral blood CD4 + T and foxp3+ Treg cells were checked by flow cytometry, and cytokine concentrations were detected by cytometric bead array.ResultsWith the gestational age growth, peripheral blood CD4 + T and foxp3+ Treg cells of prematurity gradually declined from 50% to 35% and from 8% to 6%, respectively. Meanwhile, HD-IVIG increased the percentage of CD4 + T and foxp3+ Treg cells compared with their baseline levels (p < 0.001). HD-IVIG demonstrated different regulating effects on cytokines secretion, increased IL-17 and TGF-β, and inhibited IL-6 secretion.ConclusionOur results demonstrated that HD-IVIG not only enhanced the premature immune tolerance, but also suppressed the excessive inflammation response mediated by IL-6.Trial registrationThis study was under the clinical study registration (ChiCTR-ORC-16008872, date of registration, 2016–07-21).

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Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration

Cited by 61 publications

References 24 publications

Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

Clinical Differences between Enterovirus and Human Parechovirus in Children and Infants

High-dose of intravenous immunoglobulin modulates immune tolerance in premature infants

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