881 In Infants with An Initial Diagnosis of Transient Hypogammaglobulinemia of Infancy (THI), is the Use of IV Immunoglobulin Warranted?

Abstract

Introduction: THI is a defect in a child's endogenous immunoglobulin production. It presents early following the physiological catabolism of the remnants of maternal immunoglobulin, transferred trans-placentally during the course of pregnancy. Physiological hypogammaglobulinemia normalises by 2-4 months. However during prolonged THI; the infant is rendered susceptible to a range of bacterial infections. In severe cases intravenous immunoglobulin-G (IV-IgG) replacement therapy has been proposed as treatment. Objectives: To analyse current experimental literature in order to assess the suitability of IVIgG therapy for patients diagnosed with suspected THI. Assessment of therapeutic use of IV-IgG from retrospective case controls. Further qualification of when to use IV-IgG by assessment of additional factors: symptomatology, time to normalisation of immunoglobulins and comparison with other immunodeficiency syndromes. Methods: PubMed - searched with MeSH term “hypogammaglobulinemia”; “transient hypogammaglobulinemia infancy”, “hypogammaglobulinemia IVIg”, “paediatric hypogammaglobulinaemia”. Results: Antibiotics are first-line treatment for recurrent infections. IV-IgG replacement therapy is not routinely warranted for symptomatic THI. Cases where infections are severe/resistant to conventional management, IV-IgG therapy can be considered. Other primary immunodeficiencies requiring IVIG therapy present similarly to THI as recurrent infections. In contrast THI is self-resolving with a benign clinical progression if managed appropriately; Conclusion: Most children with THI do not require IV-IgG, with the exception of severe life-threatening infections or ongoing bacterial respiratory infection despite prophylactic antibiotic therapy. In these circumstances trials of IV-IgG for 6-12 months are indicated. There are no published studies that comprehensively assess the cost-effectiveness of IV-IgG replacement in any healthcare setting for THI.