Prevention of Necrotizing Enterocolitis in Low-Birth-Weight Infants by IgA–IgG Feeding

Abstract

In a randomized clinical trial, we evaluated the efficacy of an oral immunoglobulin preparation (73 percent IgA and 26 percent IgG) in reducing the incidence of necrotizing enterocolitis in infants of low birth weight for whom breast milk from their mothers was not available. A total of 434 infants weighing between 800 and 2000 g were eligible for entry in the study. Of these, 255 were withdrawn - 234 during the first week of the study because breast milk from their mothers became available (123 in the treatment group and 111 in the control group), and 21 because of violations of protocol or because breast milk became available after the first week. The duration of follow-up was 28 days. Among the infants for whom breast milk did not become available during the study, there were no cases of necrotizing enterocolitis among the 88 receiving oral IgA-IgG, as compared with six cases among the 91 control infants (P = 0.0143). Of the infants withdrawn from the study, two assigned to the control group had necrotizing enterocolitis. We conclude that the oral administration of IgA-IgG may prevent the development of necrotizing enterocolitis in low-birth-weight infants.

Necrotizing enterocolitis: A multifactorial disease with no cure

“…A number of repor ts have been published, which suggest that oral immunoglobulins (IgA and IgG) have an immunoprotective effect on the gastrointestinal mucosa [190,191] . Premature infants have decreased levels of immunoglobulins, especially secretory IgA [192] .…”

“…Premature infants have decreased levels of immunoglobulins, especially secretory IgA [192] . A reduction in the incidence of NEC following feeding an oral IgA-IgG preparation was reported as early as 1988 [190] . A systemic review on oral immunoglobulin for the prevention of NEC did not show a significant reduction on the incidence of definite NEC [193] .…”

Dietary supplementation with ovine serum immunoglobulin attenuates acute effects on growth, organ weights, gut morphology and intestinal mucin production in the growing rat challenged with Salmonella enteritidis

“…Roos et al (1995) demonstrated that as much as 19% of ingested IgG and IgM remain immunologically active in the intestine of adult humans. Orally administered human Ig has been shown to reduce the subclinical symptoms of necrotizing enterocolitis (Eibl et al, 1988), whereas Ig has also been used therapeutically against Campylobacter jejuni (Hammarströ m et al, 1993) and Clostridium difficile (Tjellstrom et al, 1993), a major cause of diarrhoea in immunocompromised patients as well as chronic diarrhoea of unknown aetiology in normal infants . The successful treatment of Helicobacter pylori, rotavirus and cryptosporidial infection using bovine Ig has also been reported .…”

Fungal prophylaxis by reduction of fungal colonization by oral administration of bovine anti-Candida antibodies in bone marrow transplant recipients

“…Indeed, the daily oral administration of 600 mg of polyclonal human immunoglobulin from normal donors has been reported to be sufficient as prophylaxis against necrotizing enterocolitis in premature infants. 34 When bovine antibodies are used for prophylaxis, similar or lower doses as compared to human antibodies would be expected to be effective provided that the cows are specifically immunized. In challenge studies performed by Tacket and coworkers, 35 complete protection against E. coli challenge in adult volunteers was seen using a daily oral administration of 5 g of bovine immunoglobulin from hyperimmunized animals.…”