2.50
Hdl Handle:
http://hdl.handle.net/10755/157329
Type:
Presentation
Title:
INTRAVENOUS IMMUNOGLOBULIN USE IN NEONATAL INTENSIVE CARE UNIT INFANTS
Abstract:
INTRAVENOUS IMMUNOGLOBULIN USE IN NEONATAL INTENSIVE CARE UNIT INFANTS
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Purdy, Isabell B., PhD, NNP, CPNP
P.I. Institution Name:David Geffen School of Medicine at UCLA
Title:Assistant Professor of Pediatrics/ Division of Neonatology
Contact Address:10833 Le Conte Ave Room B2-375, MDCC, Los Angeles, CA, 90095-1752, USA
Co-Authors:Kellie Lim; Whitney Brown; Nikhil Singh; Richard Stiehm; Vladana Milisavljevic
PURPOSE: During the past decade, evidence supports immunotherapeutic benefits of intravenous immunoglobulin (IVIG) for premature and sick infants admitted to the neonatal intensive care unit (NICU). The aim of this study was to investigate IVIG utilization and the associated perinatal factors among this population.
BACKGROUND: Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks gestational age (GA) and endogenous synthesis does not begin until several months after birth. In general, IVIG, containing pooled immunoglobulin G, is mainly used in treatment of immune deficiencies, inflammatory and autoimmune disease and acute infections. IVIG has multiple functions including facilitating phagocytosis and endocytosis, activating complement, cytotoxicity and inflammatory mediators. Immune-related morbidities may impact infant neurodevelopment. In large part this is secondary to the immature host defense as immunodeficiencies are often exaggerated in biophysiologically stressed and early GA infants. IVIG guidelines for use in neonates and high risk infants are not as well defined as in adults. Therefore, IVIG utilization was evaluated over a 56 month period.

METHODS: A retrospective descriptive design was employed to evaluate IVIG use in a historical NICU cohort (n=1976) of infants admitted between January 2004 and June 2008. Data was abstracted from electronic medical records for perinatal diagnoses, complete blood counts and differentials pre and post IVIG and pharmacy records of NICU-IVIG. We identified 104 infants who received IVIG during the first six months of life. Analyses included descriptive statistics, cross tabulations, and regression with goodness of fit tests.

RESULTS: A gradual increase was seen in IVIG usage during this period. Most infants that received IVIG had prenatal care (89%). The majority (71%) of them survived to discharge home, 17% died, 11% were lost to follow-up. Two percent had early bacterial sepsis, 15% pneumothorax, and 17% seizures. The majority did not have necrotizing enterocolitis (84%) or low birth weight (84%). Half were inborn. Over half had major birth defects and at least one major surgery (57%) of which 8% were cardiac surgery. Additional interventions consisted of oxygen (78%), resuscitation at delivery (5%), and extracorporeal membrane oxygenation (10%). On average, the first dose was 2.27grams and was given on day of life 34. Nearly 76% received two doses and most (68%) infants were hospitalized longer than a month. Regression analysis (r-squared 0.76) identified associations with total IVIG doses that included late bacterial sepsis and GA (p< 0.0001). The most frequent reasons identified for IVIG administration were sepsis, hemolytic disease of the newborn, hypogammaglobulinemia, post-surgical and neutropenia.

CLINICAL IMPLICATIONS: First and foremost, clinicians are on the front-line of informing practice and driving policy that involves primary prevention of disease. We speculate that IVIG utilization will increase as further research clarifies the clinical benefits to neonatal immune-related morbidities and mortalities. Lack of clarity for NICU clinical practice may hamper adoption of this intervention. New guidelines based upon updated evidence from national and international clinical trials and comprehensive analyses with NICU patients would be welcomed regardless of whether they are able to cover all the complications of this vulnerable population.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleINTRAVENOUS IMMUNOGLOBULIN USE IN NEONATAL INTENSIVE CARE UNIT INFANTSen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157329-
dc.description.abstract<table><tr><td colspan="2" class="item-title">INTRAVENOUS IMMUNOGLOBULIN USE IN NEONATAL INTENSIVE CARE UNIT INFANTS</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Purdy, Isabell B., PhD, NNP, CPNP</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">David Geffen School of Medicine at UCLA</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor of Pediatrics/ Division of Neonatology</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">10833 Le Conte Ave Room B2-375, MDCC, Los Angeles, CA, 90095-1752, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ipurdy@mednet.ucla.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Kellie Lim; Whitney Brown; Nikhil Singh; Richard Stiehm; Vladana Milisavljevic</td></tr><tr><td colspan="2" class="item-abstract">PURPOSE: During the past decade, evidence supports immunotherapeutic benefits of intravenous immunoglobulin (IVIG) for premature and sick infants admitted to the neonatal intensive care unit (NICU). The aim of this study was to investigate IVIG utilization and the associated perinatal factors among this population. <br/>BACKGROUND: Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks gestational age (GA) and endogenous synthesis does not begin until several months after birth. In general, IVIG, containing pooled immunoglobulin G, is mainly used in treatment of immune deficiencies, inflammatory and autoimmune disease and acute infections. IVIG has multiple functions including facilitating phagocytosis and endocytosis, activating complement, cytotoxicity and inflammatory mediators. Immune-related morbidities may impact infant neurodevelopment. In large part this is secondary to the immature host defense as immunodeficiencies are often exaggerated in biophysiologically stressed and early GA infants. IVIG guidelines for use in neonates and high risk infants are not as well defined as in adults. Therefore, IVIG utilization was evaluated over a 56 month period.<br/><br/>METHODS: A retrospective descriptive design was employed to evaluate IVIG use in a historical NICU cohort (n=1976) of infants admitted between January 2004 and June 2008. Data was abstracted from electronic medical records for perinatal diagnoses, complete blood counts and differentials pre and post IVIG and pharmacy records of NICU-IVIG. We identified 104 infants who received IVIG during the first six months of life. Analyses included descriptive statistics, cross tabulations, and regression with goodness of fit tests. <br/><br/>RESULTS: A gradual increase was seen in IVIG usage during this period. Most infants that received IVIG had prenatal care (89%). The majority (71%) of them survived to discharge home, 17% died, 11% were lost to follow-up. Two percent had early bacterial sepsis, 15% pneumothorax, and 17% seizures. The majority did not have necrotizing enterocolitis (84%) or low birth weight (84%). Half were inborn. Over half had major birth defects and at least one major surgery (57%) of which 8% were cardiac surgery. Additional interventions consisted of oxygen (78%), resuscitation at delivery (5%), and extracorporeal membrane oxygenation (10%). On average, the first dose was 2.27grams and was given on day of life 34. Nearly 76% received two doses and most (68%) infants were hospitalized longer than a month. Regression analysis (r-squared 0.76) identified associations with total IVIG doses that included late bacterial sepsis and GA (p&lt; 0.0001). The most frequent reasons identified for IVIG administration were sepsis, hemolytic disease of the newborn, hypogammaglobulinemia, post-surgical and neutropenia. <br/><br/>CLINICAL IMPLICATIONS: First and foremost, clinicians are on the front-line of informing practice and driving policy that involves primary prevention of disease. We speculate that IVIG utilization will increase as further research clarifies the clinical benefits to neonatal immune-related morbidities and mortalities. Lack of clarity for NICU clinical practice may hamper adoption of this intervention. New guidelines based upon updated evidence from national and international clinical trials and comprehensive analyses with NICU patients would be welcomed regardless of whether they are able to cover all the complications of this vulnerable population.<br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:46:24Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:46:24Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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