Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration

Abstract

BackgroundThe benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial. ObjectTo evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections. Study designsWe retrospectively analyzed 67 neonates with culture-confirmed severe enteroviral infection, defined as hepatitis with coagulopathy and thrombocytopenia. Clinical features, outcomes and the usage of IVIG therapy were collected and analyzed. IVIG administered within 3 days of illness onset was classified as early IVIG therapy. ResultsOf the 67 cases, 38 (57%) were male, 27 (40%) were premature, 57 (85%) had disease onset within 7 days of life and all but 2 cases were caused by coxsackievirus B group. Ten infants (15%) had clinically evident myocarditis. 41 infants (61%) received IVIG therapy and 29 were early IVIG therapy. Fifteen infants (22%) eventually died, without IVIG therapy for 7 infants. The deceased had a significantly higher peak serum aspartate aminotransferase (AST) level than the survivors (3539 vs. 866IU/L, p<0.01). The timing of IVIG therapy was highly correlated with the timing of peak AST level in patients with early IVIG therapy. Multiple logistic regression analysis showed that a higher nadir hemoglobin level (adjusted odds ratio 2.8, 95% confidence interval: 1.4–5.4), no concurrent myocarditis (42.6 [3.4–5289]) and early IVIG therapy (14.7 [1.3–163]) were independently associated with a favorable prognosis. ConclusionsIn defined severe neonatal enterovirus infections, serum AST level correlated with the disease severity. Early IVIG therapy, if needed, may be beneficial for survival.