Use of Intravenous Immunoglobulin in the Treatment of Neonatal Sepsis: A Pragmatic Review and Analysis

Abstract

Objective: To review literature and assess whether adjunctive therapy with polyclonal and or enriched intravenous immunoglobulin (IVIG) reduces mortality in neonates with sepsis. Data Source: MEDLINE, EMBASE and Cochrane systematic review. Study Selection: All studies published in English language evaluating IVIG treatment in neonatal sepsis. Data Synthesis: Effect of all cause mortality was quantified using fixed-effect meta-analysis. Results: Fifteen studies published between 1986 and 2006 were identified of which fourteen reported mortality and were included in the analysis. Most studies involved small number of neonates, used different preparations and dosing regimens of IVIG, however, there was significant reduction in all cause mortality associated with use of IVIG in neonatal sepsis with pooled odds ratio of 0.41 (95% confidence interval 0.29-0.58) and a risk ratio of 0.52 (95% confidence interval 0.40- 0.67; p < 0.00001). There was no statistically significant difference between-study heterogeneity for the outcome of mortality in the two analyses. I2 = 0%. Number required to treat 7. Conclusion: This analysis shows that addition of polyclonal or enriched IVIG as adjunct to standard therapy significantly reduces all cause mortality in neonatal sepsis.