IVIg has been shown to reduce the risk of bacterial sepsis and other serious infections in preterm and low birth weight infants based on multiple randomized controlled trials. It provides passive immunity through IgG antibodies transferred from donors. While it reduces infection rates, IVIg does not lower mortality or rates of other complications. The decision to use prophylactic IVIg depends on weighing the costs against the 3-4% reduction in infection seen in trials. Further research is not needed to confirm IVIg's efficacy but rather to develop alternative prevention methods.
A presentation that addresses the myriad of issues a physician must consider when individualizing immunoglobulin replacement therapy for a patient.
Contributors:
Richard L. Wasserman MD. PhD
Medical City Children’s Hospital
Vincent R. Bonagura MD
Alexandra and Steven Cohen Children’s Medical Center NY
Carla Duff, CPNP, MSN, CCRP
University of South Florida at All Children’s Hospital
Mary Hintermeyer, MSN, CPNP
Children’s Hospital of Wisconsin
M. Elizabeth M. Younger CRNP, PhD
Johns Hopkins University School of Medicine
A New Adult Onset Acquired Immunodeficiency - Slide set by Professor Katie Fl...WAidid
A presentation of Professor Katie Flanagan on disseminated mycobacterial infection in a Malaysian lady with IFN-γ autoAbs successfully treated with Rituximab, and a review of the literature on this rare condition.
A presentation that addresses the myriad of issues a physician must consider when individualizing immunoglobulin replacement therapy for a patient.
Contributors:
Richard L. Wasserman MD. PhD
Medical City Children’s Hospital
Vincent R. Bonagura MD
Alexandra and Steven Cohen Children’s Medical Center NY
Carla Duff, CPNP, MSN, CCRP
University of South Florida at All Children’s Hospital
Mary Hintermeyer, MSN, CPNP
Children’s Hospital of Wisconsin
M. Elizabeth M. Younger CRNP, PhD
Johns Hopkins University School of Medicine
A New Adult Onset Acquired Immunodeficiency - Slide set by Professor Katie Fl...WAidid
A presentation of Professor Katie Flanagan on disseminated mycobacterial infection in a Malaysian lady with IFN-γ autoAbs successfully treated with Rituximab, and a review of the literature on this rare condition.
Presenation Overview:
IgG in PIDD: treatment goals
IgG trough levels and personalizing dose
IGIV vs IGSC: pros and cons today
Enzyme-facilitated IgG administration
Presentation by:
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology Research
Clinical Professor of Pediatrics
University of Texas Southwestern Medical School
Medical Director of Pediatric Allergy and Immunology
Medical City Children’s Hospital
Dallas, Texas
This presentation is about chronic infections in patients and earlier diagnosis of immunodeficiency. The goals of the presentation are:
1. Understand the role of innate and adaptive immune systems in the defense against infection
2. Recognize the common presentations of common primary immunodeficiencies
3. Be able to identify patients in an ENT practice that may have a primary immunodeficiency
Presentation by: Dr. Richard L. Wasserman and Dr. Scott Manning
Intravenous Immunoglobulin (IVIG) is a solution of highly purified immunoglobulin G, derived from large pools of human plasma that contains antibodies against a broad spectrum of bacterial and viral agents.
IVIG can be given safely in the convenience of your home. It can be given either intravenously (IV through the veins) or subcutaneously (under the skin).
NBN Infusions will send a nurse with all necessary supplies to complete your infusion, in the comfort of your own home.
NBN Infusions will even help you and your doctor complete all necessary documents. Our goal is to make the process as easy as possible so you can focus on getting the treatment that you need.
Insurance companies can be challenging to deal with in the IVIG treatment approval process sometimes. So, NBN Infusions will help you deal with your insurance process so that you can get approved for your IVIG treatments in a timely manner.
What Does IVIG Treat?
IVIG Therapy has been used extensively in the treatment and prevention of a variety of infectious and inflammatory diseases. Patients with compromised Immune systems who have these conditions often benefit from the passive immunity provided by IVIG therapy.
IVIG is used in patients with primary immunodeficiencies and certain conditions associated with B-cell Chronic Lymphocytic Leukemia, Pediatric HIV, and Bone Marrow Transplant. IVIG is also utilized to raise platelet counts in patients with Idiopathic Thrombocytopenic Purpura and to treat the symptoms related to other clinical conditions such as Kawasaki Syndrome.
Various other diseases and immune disorders where IVIG is used include:
Chronic Sinusitis
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Multiple Sclerosis (MS)
Myasthenia Gravis(MG)
Systenic Lupus Erythematosus (SLE)
Guillain-Barre Syndrome (GBS)
Autoimmune Diabetic Neuropathy
Polymyositis
Multifocal Motor Neuropathy (MMN)
Dermatomyositis
Rheumatoid Arthritis (RA)
Common Variable Immunodeficiency (CVID)
Hypogammaglobulinemia
Severe Combined Immunodeficiency (SCID)
Wiskott-Aldrich Syndrome (WAS)
X-Linked Agammaglobulinemia (XLA)
other connective tissue disorders
Meningococcal vaccination needed in india july 2016Gaurav Gupta
Menactra Meningococcal Conjugate Vaccine in India, is it really needed?
July 2016 Sanofi Pasteur Talk for Pediatricians, Child Specialist Doctors related to Vaccination, Immunization etc.
Group B Streptococcus (group B strep) is a type of bacteria that causes illness in people of all ages. Also known as GBS or baby strep, group B strep disease in newborns most commonly causes sepsis (infection of the blood), pneumonia (infection in the lungs), and sometimes meningitis (infection of the fluid and lining around the brain). The most common problems caused by group B strep in adults are bloodstream infections, pneumonia, skin and soft-tissue infections, and bone and joint infections.
Centers for Disease Control and Prevention:
http://www.cdc.gov/groupbstrep/about/index.html
Clinical Case of Post-Vaccination Measles Followed By Severe Neutropeniainventionjournals
We present a 13 - month old girl, who develop a post vaccination measles infection after a MMR vaccine , followed by a severe neutropenia. The hematological changes last more than one year and resolved spontaneously. We report the clinical case as an extremely rare and unknown side effect of the vaccine.
Presenation Overview:
IgG in PIDD: treatment goals
IgG trough levels and personalizing dose
IGIV vs IGSC: pros and cons today
Enzyme-facilitated IgG administration
Presentation by:
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology Research
Clinical Professor of Pediatrics
University of Texas Southwestern Medical School
Medical Director of Pediatric Allergy and Immunology
Medical City Children’s Hospital
Dallas, Texas
This presentation is about chronic infections in patients and earlier diagnosis of immunodeficiency. The goals of the presentation are:
1. Understand the role of innate and adaptive immune systems in the defense against infection
2. Recognize the common presentations of common primary immunodeficiencies
3. Be able to identify patients in an ENT practice that may have a primary immunodeficiency
Presentation by: Dr. Richard L. Wasserman and Dr. Scott Manning
Intravenous Immunoglobulin (IVIG) is a solution of highly purified immunoglobulin G, derived from large pools of human plasma that contains antibodies against a broad spectrum of bacterial and viral agents.
IVIG can be given safely in the convenience of your home. It can be given either intravenously (IV through the veins) or subcutaneously (under the skin).
NBN Infusions will send a nurse with all necessary supplies to complete your infusion, in the comfort of your own home.
NBN Infusions will even help you and your doctor complete all necessary documents. Our goal is to make the process as easy as possible so you can focus on getting the treatment that you need.
Insurance companies can be challenging to deal with in the IVIG treatment approval process sometimes. So, NBN Infusions will help you deal with your insurance process so that you can get approved for your IVIG treatments in a timely manner.
What Does IVIG Treat?
IVIG Therapy has been used extensively in the treatment and prevention of a variety of infectious and inflammatory diseases. Patients with compromised Immune systems who have these conditions often benefit from the passive immunity provided by IVIG therapy.
IVIG is used in patients with primary immunodeficiencies and certain conditions associated with B-cell Chronic Lymphocytic Leukemia, Pediatric HIV, and Bone Marrow Transplant. IVIG is also utilized to raise platelet counts in patients with Idiopathic Thrombocytopenic Purpura and to treat the symptoms related to other clinical conditions such as Kawasaki Syndrome.
Various other diseases and immune disorders where IVIG is used include:
Chronic Sinusitis
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Multiple Sclerosis (MS)
Myasthenia Gravis(MG)
Systenic Lupus Erythematosus (SLE)
Guillain-Barre Syndrome (GBS)
Autoimmune Diabetic Neuropathy
Polymyositis
Multifocal Motor Neuropathy (MMN)
Dermatomyositis
Rheumatoid Arthritis (RA)
Common Variable Immunodeficiency (CVID)
Hypogammaglobulinemia
Severe Combined Immunodeficiency (SCID)
Wiskott-Aldrich Syndrome (WAS)
X-Linked Agammaglobulinemia (XLA)
other connective tissue disorders
Meningococcal vaccination needed in india july 2016Gaurav Gupta
Menactra Meningococcal Conjugate Vaccine in India, is it really needed?
July 2016 Sanofi Pasteur Talk for Pediatricians, Child Specialist Doctors related to Vaccination, Immunization etc.
Group B Streptococcus (group B strep) is a type of bacteria that causes illness in people of all ages. Also known as GBS or baby strep, group B strep disease in newborns most commonly causes sepsis (infection of the blood), pneumonia (infection in the lungs), and sometimes meningitis (infection of the fluid and lining around the brain). The most common problems caused by group B strep in adults are bloodstream infections, pneumonia, skin and soft-tissue infections, and bone and joint infections.
Centers for Disease Control and Prevention:
http://www.cdc.gov/groupbstrep/about/index.html
Clinical Case of Post-Vaccination Measles Followed By Severe Neutropeniainventionjournals
We present a 13 - month old girl, who develop a post vaccination measles infection after a MMR vaccine , followed by a severe neutropenia. The hematological changes last more than one year and resolved spontaneously. We report the clinical case as an extremely rare and unknown side effect of the vaccine.
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
The science of maternal vaccination - Slideset by prof Kathryn EdwardsWAidid
Pregnancy is a time of immunologic changes with an increased susceptibility to some infections, and maternal immunization can provide protection to the baby through the transfer of IgG induced by vaccine across the placenta. Prof. Edwards tackles in this slide set the fundamentals of maternal immunization.
Learn more on www.waidid.org
By Dr. Usama Ragab Youssif
Definitions & Nomenclatures
Structure of immunoglobulins
Immunoglobulins in our bodies
Physiologic actions of immunoglobulins
The Idea behind use of immunoglobulins
Uses: indications, mechanisms, preparation, posology, administration
Adverse effects
Safe practice
Final bottom-line
ABO Blood grouping in-compatibility in pregnancyMs. Sapna Pal
Rhesus (Rh) incompatibility is a crucial topic in the realm of pregnancy and childbirth. This condition arises when a pregnant woman, who is Rh-negative, carries a fetus with Rh-positive blood, causing a potential mismatch that can lead to serious complications. Understanding the mechanisms and implications of Rh incompatibility is paramount for healthcare providers and expecting parents alike. Let's delve into this intricate interplay between blood types, antibodies, and pregnancy, to grasp the significance of Rh incompatibility and its management.
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Jual Obat Aborsi WA 081222292216 Obat Penggugur Kandungan Asli Obat Aborsi Cytotec & Gastrul Asli 100% Manjur Dan Aman. Obat Penggugur Kandungan, Obat Aborsi, Harga Obat Aborsi, WA 081222292216 | Jual Obat Aborsi Usia 1 Bulan, Jual Obat Aborsi Usia 2 Bulan, Jual Obat Aborsi Usia 3 Bulan, Jual Obat Aborsi Usia 4 Bulan, Jual Obat Aborsi Usia 5 Bulan, Jual Obat Aborsi Usia 6 Bulan, Cytotec Asli, Pil Cytotec, Pil Aborsi Ampuh, Obat Menggugurkan Kandungan, Obat Menghilangkan Janin, Obat Gastrul Asli, Obat Penggugur Kandungan Asli, Obat Penggugur Kandungan Usia 1-7 Bulan, Obat Telat Bulan, Obat Telat Haid, Obat Aborsi Ampuh, Obat Aborsi Cytotec, Obat Aborsi Asli, Obat Cytotec Asli. Obat Aborsi dengan obat-obatan Menggugurkan kandungan yang bisa dilakukan dengan menggunakan pil aborsi. Jika obat-obatan yang digunakan memang terjamin keasliannya dan Anda mendapatkan dari sumber terpercaya, pengobatan aborsi merupakan pilihan aman bagi kehamilan sampai 20 minggu. Ada dua cara menghentikan kehamilan dengan obat-obatan.Misoprostol atau Cytotec sajaPerempuan juga bisa menggunakan hanya Misoprostol untuk menggugurkan kandungan. Tentu saja dosnya berbeda jika dibandingkan dengan kombinasi Mifepristone dan Misoprostol. Tingkat keberhasilannya bisa mencapai 99%. Lalu, apa itu cytotec? Cytotec adalah nama merek dagang dari Misoprostol. Nama lain yang mungkin sering disebut di Indonesia adalah gastrul, misotab, dan chromelux. Pahami Bahaya Penggunaan Obat Aborsi Tanpa Pengawasan Dokter Saat ini banyak produk obat aborsi yang dijual “gelap” atau tanpa resep dokter. Perlu diketahui, obat tersebut bukan obat yang diracik khusus untuk menggugurkan kandungan. Misoprostol misalnya, sebenarnya diproduksi untuk mengobati penyakit lambung. Namun, obat tersebut diketahui memicu kontraksi dan meluruhkan dinding rahim. Kondisi ini bisa berefek pada gugurnya janin jika dikonsumsi oleh ibu hamil. Aborsi yang dilakukan dengan obat misoprostol biasanya digunakan saat usia kehamilan di bawah 25 minggu atau 6 bulan. Pada beberapa kasus, misoprostol digunakan secara bersamaan dengan obat lain, seperti mifepristone. Namun, mifepristone cenderung sulit didapat dan harganya jauh lebih mahal daripada misoprostol, sehingga banyak orang yang menggunakan misoprostol saja. Lalu, apakah berbahaya mengonsumsi obat aborsi tanpa pengawasan dokter? Tentu saja sudah. Sebab, hanya dokter dan tenaga kesehatan yang dapat menentukan apakah obat-obatan tersebut aman dikonsumsi. Selain itu, saran yang dibutuhkan dari dokter terkait dengan apa yang harus digunakan, aturan penggunaan, dan obat-obatan lain yang harus digunakan untuk meringankan gejala yang muncul ak
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
India Diagnostic Labs Market: Dynamics, Key Players, and Industry Projections...Kumar Satyam
According to the TechSci Research report titled “India Diagnostic Labs Market Industry Size, Share, Trends, Competition, Opportunity, and Forecast, 2019-2029,” the India Diagnostic Labs Market was valued at USD 16,471.21 million in 2023 and is projected to grow at an impressive compound annual growth rate (CAGR) of 11.55% through 2029. This significant growth can be attributed to various factors, including collaborations and partnerships among leading companies, the expansion of diagnostic chains, and increasing accessibility to diagnostic services across the country. This comprehensive report delves into the market dynamics, recent trends, drivers, competitive landscape, and benefits of the research report, providing a detailed analysis of the India Diagnostic Labs Market.
Collaborations and Partnerships
Collaborations and partnerships among leading companies play a pivotal role in driving the growth of the India Diagnostic Labs Market. These strategic alliances allow companies to merge their expertise, strengthen their market positions, and offer innovative solutions. By combining resources, companies can enhance their research and development capabilities, expand their product portfolios, and improve their distribution networks. These collaborations also facilitate the sharing of technological advancements and best practices, contributing to the overall growth of the market.
Expansion of Diagnostic Chains
The expansion of diagnostic chains is a driving force behind the growing demand for diagnostic lab services. Diagnostic chains often establish multiple laboratories and diagnostic centers in various cities and regions, including urban and rural areas. This expanded network makes diagnostic services more accessible to a larger portion of the population, addressing healthcare disparities and reaching underserved populations. The presence of diagnostic chain facilities in multiple locations within a city or region provides convenience for patients, reducing travel time and effort. A broader network of labs often leads to reduced waiting times for appointments and sample collection, ensuring that patients receive timely and efficient diagnostic services.
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The increasing prevalence of chronic diseases is a significant driver for the demand for diagnostic lab services. Chronic conditions such as diabetes, cardiovascular diseases, and cancer require regular monitoring and diagnostic testing for effective management. The rise in chronic diseases necessitates the use of advanced diagnostic tools and technologies, driving the growth of the diagnostic labs market. Additionally, early diagnosis and timely intervention are crucial for managing chronic diseases, further boosting the demand for diagnostic lab services.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
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The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
2. Immunoglobulins
Circulating antibodies protect their
host by binding to and neutralizing
some protein toxins, by blocking the
attachment of some viruses and
bacteria to cells, by opsonizing
bacteria and by activating
complement.
Produced by Plasma Cells
GAMDE
3. Classes of Immunoglobulins
IgG
IgA
IgM
IgD
IgE
GAMDE 5 classes of Immunoglobulin
IG1= 66
IG2= 23
IG3=7
IG4=4
4. IgG
The major immunoglobulin in the blood, makes up 70% to 75% of the
total immunoglobulin pool.
The serum half-life of IgG is 23 days.
The only immunoglobulin capable of crossing the placenta and is thus
a major defense mechanism in the early part of an infant’s life.
Neutralize viruses and toxins, opsonize bacteria, and activate the
complement system.
5. IgG is an answer to
Autoimmune Disorders
Primary Immunodeficiency
8. Properties of IVIG
Pro-inflammatory
opsonic activity
fixation of complement
antibody dependent cytotoxicity
neutrophil chemiluminescence
phagocytosis
release of stored neutrophils
Anti-inflammatory
Down-regulation of inflammatory cytokines via
Fc receptor blockade,
provision of anti-idiotype antibodies
interference with activation of
T-cells
B-cells
the cytokine network
complement
Immunomodulation of autoimmune and inflammatory diseases
with intravenous immune globulin.
Kazatchkine MD,. et al. N Engl J Med 2001
11. Humoral Immunity in NewBorns
Humoral immunity of the human newborn is provided primarily by maternal immunoglobulin G (IgG)
transferred transplacentally beginning at 8 to 10 weeks of gestation and accelerating during the last
trimester.
The lack of opsonic antibody is an important risk factor for susceptibility of newborns to infections
caused by many bacteria with polysaccharide capsules (eg, group B Streptococcus, Escherichia coli,
Haemophilus influenzae type b, Streptococcus pneumoniae) that cause serious bacterial infections in
newborns.
11Prof Ariyanto Harsono MD PhD SpA(K)
12. IgG in Preterm Infants
Premature infants, compared to full-term infants, have lower levels of IgG at birth that further
decreases during the first few weeks of life.
The relative deficiency of humoral immunity in premature newborns may contribute to the
inverse correlation of birth weight and rate of neonatal sepsis.
With an 86-fold increased rate of sepsis in newborns of birth weight 600 to 999 grams compared
to newborns of birth weight of more than 2500 grams.
Infants born prematurely are also at risk for nosocomial infections resulting from prolonged
hospitalization.
Prof Ariyanto Harsono MD PhD SpA(K) 12
13. Need for IVIG in Preterm Infants
The benefit of passive immunization by prophylactic administration of intravenous immune
globulin (IVIG) for prevention of bacterial infections has been established for patients with
primary a gammaglobulinemia and with symptomatic human immunodeficiency virus infection.
Routine administration of IVIG for other immunocompromised hosts has not consistently been
shown to clearly decrease the incidence of bacterial infections.
Therapeutic IVIG and monoclonal antibodies to gram negative bacteria have been studied as
adjunctive treatment for bacterial sepsis and shock but their effectiveness remains controversial.
13Prof Ariyanto Harsono MD PhD SpA(K)
15. Incidence of Thrombocytopenia
Neonatal alloimmune/ autoimmune
thrombocytopenia
o Incidence 1 per 1000
o First reports of IVIG in 1980s
o No RCTs
Immune-mediated thrombocytopenia
(Idiopathic thrombocytopenia - ITP)
o Extremely rare in newborns
o First reports of IVIG in 1981
o Subsequently effective in RCTs
o FDA approved
16. IVIG binds to the sensitised red cells.
IVIG Fc portion (fork handle) blocks the Fc receptor on
macrophages
IVIG upregulates inhibitory Fcγ RIIB receptors on macrophages.
This inhibits phagocytosis.
Possible mechanisms of IVIG in ITP
17. Guidelines for treatment of
Neonatal Autoimmune
Thrombocytopenia
Neonatal thrombocytopenia secondary to maternal
ITP may last for months and requires long-term
monitoring and occasionally a second dose of IVIg at
4 to 6 weeks after birth.
18.
19. Where there is delay in obtaining HPA-compatible
platelets, random donor platelet transfusions or
intravenous immunoglobulin (IVIG) can be used as
they often produce a significant platelet increment
in NAIT although the rise in platelet count after
IVIG may be delayed for at least 36 h
In some cases thrombocytopenia may persist for
up to 8–12 weeks. In such cases, IVIG usually
provides a better alternative to repeated platelet
transfusions.
23. IVIG IN HDN -AAP GUIDELINES
Indication: Hemolytic disease of newborn with significant
hyperbilirubinemia
Dose: 0.5-1gm/kg
Mode of administration: Infusion given over 2-4 hrs.
Monitoring: For adverse reactions
(Pediatrics 2004;114:297-316)
24. IVIG for Rhesus disease and ABO incompatibility:
Two systematic reviews of the same data
1. Alcock GS, Liley H. Cochrane Review 2002
2. Gottstein R, Cooke RW. Arch Dis Child Fetal Neonatal 2003
In 3 RCTs in 199 infants, IVIG led to
Fewer exchange transfusions
Relative Risk 0.28 (0.17 – 0.47)
Shorter phototherapy and hospital stay
No data on disability-free survival
25. Reduced need for exchange transfusion with IVIG vs
standard treatment for haemolytic jaundice:
Number needed to treat 2.7 (95% CI 2.0 to 3.8).
26. Similar results: differing conclusions
Alcock GS, Liley H. Cochrane Review 2002
‘Well designed studies are needed before
routine use of IVIG can be
recommended.’
Gottstein R, Cooke RWI. Arch Dis Child Fetal Neonatal 2003
‘IVIG is an effective treatment.’
28. Intravenous immunoglobulin for suspected or
subsequently proven infection in neonates
Lacy J, Ohlsson A. Arch Dis Child 1995;72:F151-5
Ohlsson A, Lacy J. Cochrane Library, January 1998
Ohlsson A, Lacy J. Cochrane Library, February 2001
Unpublished update September, 2003
29. Background
Nosocomial infections continue to be a significant cause of
morbidity and mortality among preterm and/or low birth weight
infants
Maternal transport of immunoglobulins to the fetus occurs mainly
after 32 weeks gestation
Endogenous synthesis does not begin until several months after
birth
30. Background
Administration of intravenous immunoglobulin provides IgG that can:
bind to cell surface receptors
provide opsonic activity
activate complement
promote antibody dependent cytotoxicity
improve neutrophilic chemoluminescence
31. IVIG has the potential of:
Preventing serious nosocomial infections
Altering the course of congenital or nosocomial infections
32. Study Details
Objective
To assess the effectiveness/safety of IVIG administration - compared to placebo or no intervention - to preterm (< 37 weeks
gestational age at birth) and/or low birth weight (< 2500 g) infants in preventing nosocomial infections
Results
When 10 studies (n = 3,975) were combined there was a statistically significant reduction in sepsis (one or more episodes)
When 16 studies (n = 4,986) were combined there was a statistically significant reduction in any serious infection (one or more
episodes)
There were no statistically significant differences for:
mortality from all causes
mortality from infection
NEC, BPD, IVH
length of hospital stay
no major adverse effects of IVIG were reported in any of the studies
a rise in serum IgG was noted in all studies that reported on this outcome
33. Main results
There were no statistically significant differences for:
mortality from all causes
mortality from infection
NEC, BPD, IVH
length of hospital stay
no major adverse effects of IVIG were reported in any of the studies
a rise in serum IgG was noted in all studies that reported on this outcome
34.
35. Attempts to explain across study
heterogeneity in a systematic review
of prophylactic administration of
intravenous immunoglobulin (IVIG) in
neonates
Beyene J, Shah V, Ohlsson A
36. Comparison: IVIG vs placebo/no treatment
Outcome: Any serious infection (RR)
37. Comparison: IVIG vs placebo/no treatment
Outcome: Any serious infection (RD)
40. Conclusions
Statistically significant in-between study heterogeneity was present
due to differences in control group event rates
IVIG administration results in a 3-4% reduction in sepsis and/or any
serious infection
Is not associated with reductions in other morbidities: NEC, IVH,
length of hospital stay or mortality
Prophylactic use of IVIG is not associated with any short term
serious side effects
41. Conclusions
The decision to use prophylactic IVIG will depend on the costs
and the values assigned to the clinical outcomes
There is no justification for further RCTs testing the efficacy of
previously studied IVIG preparations to reduce nosocomial
infections in preterm and/or LBW infants
The results of these meta-analyses should encourage basic
scientists and clinicians to pursue other avenues to prevent
nosocomial infections
42. Intravenous immunoglobulin for
suspected or subsequently
proven infection in neonates
Lacy J, Ohlsson A. Arch Dis Child 1995;72:F151-5
Ohlsson A, Lacy J. Cochrane Library, January 1998
Ohlsson A, Lacy J. Cochrane Library, February 2001
Unpublished update September, 2003
43. Objectives
To assess the effectiveness of intravenous immunoglobulin
(IVIG) to reduce mortality/morbidity caused by suspected
infection in newborn infants
In secondary analyses to assess the effectiveness of IVIG to
reduce mortality/morbidity in those neonates, who entered
into the studies with suspected infection and who later were
confirmed as being infected.
44. Main results
Six of 9 identified studies (n = 318) reported on the outcomes of all
randomized patients with clinically suspected infection
Mortality was not reduced (borderline statistical significance)
RR 0.63 (95% CI; 0.40, 1.00)
RD – 0.09 (95% CI; 0.00, - 0.17)
No statistically significant between study heterogeneity
45. Main results
Treatment with IVIG (seven trials,
n = 262) in cases of subsequently proved infection did result
in a statistically significant reduction in mortality
RR 0.55 (95% CI; 0.31, 0.98)
RD -0.09 (95% CI; - 0.01, - 0.18)
NNT 11 (95% CI; 6, 100)
There was no statistically significant between-study
heterogeneity
46.
47.
48.
49. Conclusions
The reduced mortality following treatment with IVIG for suspected sepsis and the imprecise
estimate of the effect size to prevent one death (NNT 11, 95% CI; 6, 100) justify further research
50. Conclusions
The role of IVIG preparations with high concentrations of antibodies to specific organisms should
be evaluated
If such trials are to be undertaken, the design should include long-term follow-up assessment
and cost-effectiveness evaluation
51. Conclusions
Researchers should be encouraged to undertake well-designed trials to confirm or refute the
effectiveness of IVIG to reduce adverse outcomes in neonates with suspected infection