Article type
Year
Abstract
Objective: To determine the effectiveness of intravenous immunoglobulin (IVIG) administration to premature and/or treatment of bacterial infection.
Methods: Studies were identified through computer searches of MEDLINE, EMBASE, SCISEARCH and Oxford Database of Perinatal Trials and extensive hand search of bibliographies of all identified articles. Study selection: Two independent judges applied the following inclusion criteria: randomized controlled trial with a control group that received no intervention, premature and/or LBW infant, use of IVIG, and infection or mortality outcome. The judges accepted 17 of 40 studies for inclusion. Data extraction: The same judges assessed study quality (intraclass correlation coefficient = 0.98). Descriptive and quantitative information on study population, intervention and outcomes was collected independently by the judges.
Results: Studies were divided into prophylaxis or treatment and the results of the studies were combined for infection, sepsis, necrotizing enterocolitis, death from all causes and death from infection and analyzed using Mantel-Haenszel relative risk (RR) with 95% confidence intervals (CIs). For 15 studies of prophylaxis (N=4435) the RR and CI were, for infection: 0.81, 0.73-0.91, for sepsis: 0.87, 0.75-1.0 and for death from all causes: 0.90, 0.74-1.08. Some of the outcome results were heterogenous. The 2 studies using IVIG for treatment showed no combined reduction in mortality.
Discussion: In spite of the large number of patients who have been studied, the benefits of IVIG are modest. As its use is associated with considerable cost, we do not recommend the routine administration of IVIG to preterm infants at the present time.
Methods: Studies were identified through computer searches of MEDLINE, EMBASE, SCISEARCH and Oxford Database of Perinatal Trials and extensive hand search of bibliographies of all identified articles. Study selection: Two independent judges applied the following inclusion criteria: randomized controlled trial with a control group that received no intervention, premature and/or LBW infant, use of IVIG, and infection or mortality outcome. The judges accepted 17 of 40 studies for inclusion. Data extraction: The same judges assessed study quality (intraclass correlation coefficient = 0.98). Descriptive and quantitative information on study population, intervention and outcomes was collected independently by the judges.
Results: Studies were divided into prophylaxis or treatment and the results of the studies were combined for infection, sepsis, necrotizing enterocolitis, death from all causes and death from infection and analyzed using Mantel-Haenszel relative risk (RR) with 95% confidence intervals (CIs). For 15 studies of prophylaxis (N=4435) the RR and CI were, for infection: 0.81, 0.73-0.91, for sepsis: 0.87, 0.75-1.0 and for death from all causes: 0.90, 0.74-1.08. Some of the outcome results were heterogenous. The 2 studies using IVIG for treatment showed no combined reduction in mortality.
Discussion: In spite of the large number of patients who have been studied, the benefits of IVIG are modest. As its use is associated with considerable cost, we do not recommend the routine administration of IVIG to preterm infants at the present time.