Exchange transfusion or intravenous immunoglobulin therapy as an adjunct to antibiotics for neonatal sepsis in developing countries: a pilot study

Abstract

A total of 88 infants with sepsis and gestational ages ranging from 32 to <37 weeks were enrolled consecutively. The effect of ET with fresh, whole blood and IVIG on immunoglobulin G and M levels was monitored over a 24-hour period. ET was performed on 33 infants, 33 infants received IVIG and 22 infants served as controls. There were nine deaths (27%) in the IVIG group, seven (21%) in the ET group and nine (41%) in the control group (p>0.05). IgG levels rose significantly 12 hours after administration of IVIG (p<0.01). There were no differences between the initial and 24-hour IgG levels in the IVIG group. IgG levels did not change significantly in the ET and control groups. IgM levels rose significantly 12 hours after ET and elevated IgM levels persisted for over 24 hours.

Double Volume Exchange Transfusion in Severe Neonatal Sepsis

“…In those who underwent DVET, the donor blood had a mean (± SD) hematocrit (in %) of 55±6; pH of 6.75±0.07; base deficit of −21±5, potassium of 10±4 mEq/L and a median (IQR) HCO 3 of 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). None of the donor blood was deficient in Glucose-6-phosphate dehydrogenase enzyme.…”

“…Despite these theoretical benefits, evidence for clinical efficacy and safety of DVET has not been rigorously evaluated. Out of 11 controlled trials (3 randomized and 8 non-randomized) done in 570 neonates, six have shown a significant improvement in survival in the DVET group in comparison to no DVET [5][6][7][8][9][10][11][12][13][14]. However, all studies were heterogeneous with regards to patient characteristics, eligibility criteria, stage and severity of sepsis at enrollment, study design and steps taken to minimize the bias, type of blood used and outcomes analyzed.…”

Immunoglobulins in the Prevention and Treatment of Neonatal Sepsis

“…They found 10 studies meeting their inclusion criteria that differed to the above mentioned analysis (30) by additional including the small study of Christensen et al (45) and a new study by Ahmend et al (46) and not including the studies by El Nawawy (32), Gökalp (38), and Gunes (31).The results showed a statistically significant reduction in mortality in cases of proven and also of suspected infection with a NNT of 10 infants (95% CI; 6, 33) to avoid one death.…”

“…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.…”