El-Nawawy Ahmed, El-Kinany Hassan, Hamdy El-Sayed Mona, Boshra Nevine
Pediatric Department, Faculty of Medicine, Alexandria University, Egypt.
J Trop Pediatr. 2005 Oct;51(5):271-8. doi: 10.1093/tropej/fmi011. Epub 2005 May 25.
Life-threatening infections account for about 25 per cent of children requiring admission to pediatric intensive care units (PICU). The results of the use of polyclonal intravenous immunoglobulins as an adjuvant in pediatric sepsis syndrome therapy are conflicting. A prospective study of 100 sepsis syndrome PICU patients aged 1-24 months and divided into two matching groups (septic cases and control, 50 patients each) was performed. All patients were treated according to the routine protocol PICU therapy. Only the cases group received, in addition, polyclonal IVIG (Pentaglobin, Biotest) in a dose of 400 mg/kg for 3 days. All cases were evaluated for PRISM III score 8 h after admission; routine blood, urine, stool and cerebrospinal fluid (whenever appropriate) culture. Daily laboratory examination (blood gases, electrolytes, liver and renal functions, complete blood picture and C-reactive protein) were performed for the first 5 days. Blood samples were obtained for evaluation of tumor necrosis factor-alpha (TNF-alpha) daily for the first 5 days. Referral site (ward or casuality), length of PICU stay (LOS) and outcome (discharged or deceased), the number and percentage of cases who progressed to complications were recorded. Results showed that group I had a significantly higher percentage of discharged cases (72 per cent vs. 44 per cent), significantly shorter LOS (6.1 days vs. 9.1 days), and a significantly lower percentage of progress to complications (8 per cent vs. 32 per cent) especially disseminated intravascular coagulation (4 per cent vs. 24 per cent). TNF-alpha was significantly reduced among septic cases on discharge (2.24 vs. 3.6 mg/dl, p<0.001). A multiple logistic regression model revealed that treatment with IVIG, LOS, severity of sepsis and lymphocyte percentage (L per cent) on admission were significant predictors for survival. In summary the study revealed that the use of polyclonal IVIG among PICU sepsis syndrome showed a significant reduction in mortality, LOS and less progress to complications. A multicenter study is recommended to confirm these results.
危及生命的感染约占需要入住儿科重症监护病房（PICU）儿童的25%。使用多克隆静脉注射免疫球蛋白作为小儿脓毒症综合征治疗辅助药物的结果存在争议。对100例年龄在1 - 24个月的脓毒症综合征PICU患者进行了一项前瞻性研究，将其分为两个匹配组（脓毒症病例组和对照组，每组50例）。所有患者均按照PICU常规治疗方案进行治疗。仅病例组另外接受了剂量为400mg/kg的多克隆静脉注射免疫球蛋白（Pentaglobin，Biotest），持续3天。所有病例在入院8小时后评估PRISM III评分；进行常规血液、尿液、粪便和脑脊液（酌情）培养。在最初5天每天进行实验室检查（血气、电解质、肝肾功能、全血细胞计数和C反应蛋白）。在最初5天每天采集血样以评估肿瘤坏死因子-α（TNF-α）。记录转诊地点（病房或急诊室）、PICU住院时间（LOS）和结局（出院或死亡），以及进展为并发症的病例数量和百分比。结果显示，第一组出院病例的百分比显著更高（72%对44%），LOS显著更短（6.1天对9.1天），进展为并发症的百分比显著更低（8%对32%），尤其是弥散性血管内凝血（4%对24%）。脓毒症病例出院时TNF-α显著降低（2.24对3.6mg/dl，p<0.001）。多因素逻辑回归模型显示，静脉注射免疫球蛋白治疗、LOS、脓毒症严重程度和入院时淋巴细胞百分比（L%）是生存的重要预测因素。总之，该研究表明，在PICU脓毒症综合征中使用多克隆静脉注射免疫球蛋白可显著降低死亡率、缩短LOS并减少进展为并发症的情况。建议进行多中心研究以证实这些结果。
