Outcomes of Newborn Infants with Neonatal Sepsis Receiving IgM-Enriched Intravenous Immunoglobulin as Adjunctive Treatment
Kankamol Charoenwong¹, Pongsatorn Paopongsawan¹, Junya Jirapradittha¹, Pakaphan Kiatchoosakun¹
Affiliation : ¹ Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Neonatal sepsis is a major cause of morbidities and mortality in newborn infants. Adjunctive treatment with IgM-enriched intravenous immunoglobulins (IgM-enriched IVIG) may improve the outcomes of the newborn infants with neonatal sepsis. However, there is limited data with regards to the outcomes of newborn infants receiving this treatment.
Objective: To evaluate the outcomes of the newborn infants with neonatal sepsis receiving IgM-enriched IVIG.
Materials and Methods: A retrospective cohort study was done in newborn infants aged 28 days or younger diagnosed with either culture-proven sepsis or clinical sepsis at Srinagarind Hospital between 2012 and 2018. The outcomes with regards to death and morbidities were compared between newborn infants received IgM-enriched IVIG versus a control group.
Results: Ninety-six newborn infants were eligible for the present study. Culture-proven sepsis group consisted of 20 newborn, which five of them had early-onset sepsis (EOS) and 15 had late-onset sepsis (LOS). There were 76 newborn infants in clinical sepsis group, which 36 had EOS and 40 had LOS. IgM-enriched IVIG was given to 12 (60%) newborn infants with culture-proven sepsis and 10 (13.2%) newborn infants with clinical sepsis. Among newborn infants diagnosed with culture-proven EOS and LOS, there was no significant differences in morbidities, mortality, length of hospital stay, and hospital cost between the intervention and the control group. In newborn infants diagnosed with clinical sepsis, subgroup analysis showed that in clinical LOS, the intervention group had significantly higher rate of death at 25% versus 0% (OR 6.3; 95% CI 3.0 to 13.2, p<0.05) and hospital cost with a mean of 601,155 versus 279,777 Baht (p<0.05) in comparison to the control group.
Conclusion: IgM-enriched IVIG failed to demonstrate benefit as an adjunctive treatment for newborn infants with neonatal sepsis. It also failed to show reduction in length of hospital stay and hospital cost. Routine prescription of IgM-enriched IVIG in neonatal sepsis is not recommended.
Received 30 August 2021 | Revised 9 February 2022 | Accepted 14 February 2022
DOI: 10.35755/jmedassocthai.2022.05.13305
Keywords : Neonatal sepsis; IgM-enriched IVIG; Outcomes
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