Intravenous gammaglobulin therapy for prophylaxis of infection in high-risk neonates

Chirico, G; Rondini, G; Plebani, Alessandro; Chiara, A; Massa, Margherita; Ugazio, Alberto G.

doi:10.1016/s0022-3476(87)80514-0

Cited by 156 publications

(50 citation statements)

References 25 publications

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“…While there is a growing body of literature on the use of IVIG in preterm and newborn infants (3,5,7,24), little pharmacokinetic information exists for young children. We utilized a noncompartmental model and assumed that IVIG followed linear pharmacokinetics; this model has been validated in other studies (3,5,9,24). Assuming a volume of distribution of 26%, we calculated that IVIG with an RSV Nt antibody titer of 1:1,100 given in doses ranging between 500 and 750 mg/kg should achieve a titer of 1:100.…”

Section: Discussionmentioning

confidence: 99%

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Groothuis

Levin

Rodríguez

et al. 1991

Antimicrob Agents Chemother

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Infants with cardiopulmonary disease develop severe illness from respiratory syncytial virus (RSV) infection. Safety, feasibility, and pharmacokinetics of intravenous gamma globulin (IVIG) to prevent RSV illness were studied in 23 high-risk infants in a phase I trial. IVIG with an RSV neutralizing antibody titer of 1:1,100 in 5% solution was given monthly over a 2-to 4-h period in a clinical setting during the RSV season. The first group (n = 7) received 500 mg/kg of body weight, the second group (n = 9) received 600 mg/kg, and the third group (n = 7) received 750 mg/kg. Serum was drawn prior to infusion and 2, 14, and 30 days after infusion. Total immunoglobulin G and RSV A2 and RSV neutralizing antibody levels were obtained after the first IVIG infusion. Two children developed mild reversible pulmonary edema (group receiving 600 mg/kg per dose), and one developed hives and wheezing during one infusion (group receiving 500 mg/kg per dose). Twelve children developed subsequent RSV infection during two RSV seasons (November to April) over a 2-year follow-up period; 9 of 12 developed infection during the infusion year. Eleven illnesses were mild; one child died of progressive RSV illness (group receiving 500 mg/kg per dose). A cumulative infusion effect was not observed. IVIG appears safe and feasible in an outpatient setting, and at 750 mg/kg per dose, a target RSV antibody level of 21:100 was achieved.Respiratory syncytial virus (RSV) is the most common cause of serious respiratory illness in young children (2, 8). Children at greatest risk of serious or fatal RSV lower respiratory tract illness include those with bronchopulmonary dysplasia and congenital heart disease (10-12, 21, 22). Because the level of morbidity is so great in these populations, prevention of serious RSV lower respiratory tract illness is an important goal.It is unlikely that a live vaccine will be available in the near future to prevent high-risk young children from developing serious RSV infection. Vaccine development is proceeding cautiously because of the problem in developing a live vaccine which is safe, stable, and immunogenic and to avoid the serious pulmonary complications seen 20 years ago with the use of a formalin-inactivated vaccine (18

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Section: Discussionmentioning

confidence: 99%

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Groothuis

Levin

Rodríguez

et al. 1991

Antimicrob Agents Chemother

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“…Therefore, it has been proposed that prophylaxis with immunoglobulins might prevent septic complications in the premature infant. In fact, several studies suggest that this is possible (7,14). Perhaps the most compelling study reported to date is from Italy (7).…”

Section: New Uses Of Igiv For Prophylaxismentioning

confidence: 99%

Newer uses of intravenous immunoglobulins as anti-infective agents

Pennington

1990

Antimicrob Agents Chemother

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“…Intravenous immunoglobulin (IVIG) has been widely used prophylactically in premature neonates at risk for septicaemia [13][14][15][16][17][18], and actually has been incorporated into the treatment regimen of bacterial infections of neonates [19][20][21][22][23]. IVIG has been shown to yield a favourable clinical outcome in certain neonates [13][14][15][19][20][21], but several groups have suggested that IVIG has neither prophylactic nor therapeutic effect on such neonates [16][17][18]22,23]. Although bacterial clearance by IVIG therapy has been investigated in vivo [24,25], there has been no study of PMN functions associated with IVIG therapy in vivo and in vitro.…”

Section: Introductionmentioning

confidence: 99%

Effect of immunoglobulin therapy on phagocytosis by polymorphonuclear leucocytes in whole blood of neonates

Fujiwara

Taniuchi

Hattori

et al. 1997

Clinical and Experimental Immunology

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SUMMARYThere has been some disagreement as to the clinical effect of intravenous immunoglobulin (IVIG) therapy on neonatal bacterial infections. We therefore evaluated the effect of IVIG therapy on neonatal polymorphonuclear leucocyte (PMN) functions by monitoring phagocytosis and hydrogen peroxide (H 2 O 2 ) production. Subjects were 10 mature neonates who had normal plasma levels (i.e. equal to adult plasma levels) of IgG and nine premature neonates who had lower plasma levels of IgG. Phagocytosis by PMN was measured using flow cytometric analysis of whole blood. Addition of g-globulin to the whole blood of mature neonates increased phagocytosis, but not significantly. Higher doses of added g-globulin (> 2·0 mg/ml, the concentration was expressed as that in the final reaction volume) decreased phagocytosis to under baseline level. In premature neonates addition of g-globulin increased phagocytosis and the significant maximum effect was observed with 0·5 mg/ml of the additional g-globulin.Higher doses of additional g-globulin (2·5 mg/ml) decreased phagocytosis to baseline level. Phagocytosis in four mature and four premature neonates was compared before and after 1 g/kg of IVIG therapy. Phagocytosis in mature neonates after IVIG therapy did not change compared with the pretreatment level. On the other hand, phagocytosis in premature neonates after IVIG therapy significantly increased compared with its pretreatment level. In both mature and premature neonates H 2 O 2 production following phagocytosis varied in parallel with changes of phagocytosis. The patterns of H 2 O 2 production following phagocytosis were essentially similar to those observed with phagocytosis. The above results are expected to form the basis for a rational indication for IVIG therapy against bacterial infections in neonates with low plasma IgG levels.

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Intravenous gammaglobulin therapy for prophylaxis of infection in high-risk neonates

Cited by 156 publications

References 25 publications

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics. The RSVIG Study Group

Newer uses of intravenous immunoglobulins as anti-infective agents

Effect of immunoglobulin therapy on phagocytosis by polymorphonuclear leucocytes in whole blood of neonates

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