Intravenous immunoglobulin prophylaxis of late-onset sepsis in preterm neonates

Advances in neonatal care during the past 15 years have resulted in an increased survival rate for preterm newborn infants with birth weight of less than 1500 grams. Despite therapeutic improvements, infection remains a major problem in this group of babies due to their increased susceptibility to infection. In a double blind, placebo controlled trial, we investigated the effect of intravenous immunoglobulin (IgG) in the prevention of nosocomial infection in very low birth weight infants (with birth weight ≤ 1500 grams and gestational age ≤ 32 weeks). Patients were recruited from the Neonatal Intensive Care Unit at the Glasgow Royal Maternity Hospital. Thirty eight infants were enrolled into the trial and all needed intensive life support and/or parenteral nutrition through a long line. After randomisation 19 were given IVIG and 19 were used as controls. Four babies died early in the study and were excluded. The babies were intensively monitored during the study period for the number of proven or suspected episodes of infection and any complication of therapy. Additional information about their ability to resist infection was obtained by checking their opsonic activity. Babies ≤ 1000 grams birth weight were given 700 mg/kg of IVIG. Babies with 1001 - 1500 grams were given 500 mg/kg of IVIG. The placebo given to control group was 5 % dextrose. These doses were repeated at two weekly intervals so long as the babies needed intensive care. We conclude that the administration of IVIG did not provide effective prophylaxis for late-onset sepsis. IVIG appears to be well tolerated by very low birth weight infants. No significant side effects were observed