Intravenous Polyclonal Immunoglobulin Administration to Sepsis Syndrome Patients: A Prospective Study in a Pediatric Intensive Care Unit

• Published in: Journal of tropical pediatrics (1980) 2005-10, Vol.51 (5), p.271-278
• Main Authors: El-Nawawy, Ahmed, El-Kinany, Hassan, Hamdy El-Sayed, Mona, Boshra, Nevine
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Case-Control Studies; Egypt; Female; General aspects; Humans; Immunoglobulins, Intravenous - therapeutic use; Infant; Intensive Care Units, Pediatric; Logistic Models; Male; Medical sciences; Prospective Studies; Severity of Illness Index; Systemic Inflammatory Response Syndrome - classification; Systemic Inflammatory Response Syndrome - drug therapy; Systemic Inflammatory Response Syndrome - mortality
• ISSN: 0142-6338; 1465-3664
• DOI: 10.1093/tropej/fmi011

Life-threatening infections account for about 25 per cent of children requiring admission to pediatric intensive care units (PICU). The results of the use of polyclonal intravenous immunoglobulins as an adjuvant in pediatric sepsis syndrome therapy are conflicting. A prospective study of 100 sepsis syndrome PICU patients aged 1–24 months and divided into two matching groups (septic cases and control, 50 patients each) was performed. All patients were treated according to the routine protocol PICU therapy. Only the cases group received, in addition, polyclonal IVIG (Pentaglobin, Biotest) in a dose of 400 mg/kg for 3 days. All cases were evaluated for PRISM III score 8 h after admission; routine blood, urine, stool and cerebrospinal fluid (whenever appropriate) culture. Daily laboratory examination (blood gases, electrolytes, liver and renal functions, complete blood picture and C-reactive protein) were performed for the first 5 days. Blood samples were obtained for evaluation of tumor necrosis factor-alpha (TNF-α) daily for the first 5 days. Referral site (ward or casuality), length of PICU stay (LOS) and outcome (discharged or deceased), the number and percentage of cases who progressed to complications were recorded. Results showed that group I had a significantly higher percentage of discharged cases (72 per cent vs. 44 per cent), significantly shorter LOS (6.1 days vs. 9.1 days), and a significantly lower percentage of progress to complications (8 per cent vs. 32 per cent) especially disseminated intravascular coagulation (4 per cent vs. 24 per cent). TNF-α was significantly reduced among septic cases on discharge (2.24 vs. 3.6 mg/dl, p