Dinleyici Ener Cagri, Frey Georg, Kola Ermira, Wippermann Ulrike, Bauhofer Artur, Staus Alexander, Griffiths Peter, Azharry Muhamad, Rohsiswatmo Rinawati
Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Türkiye.
Klinik für Neonatologie, Darmstädter Kinderkliniken Prinzessin Margaret, Perinatalzentrum Südhessen, Darmstadt, Germany.
Front Pediatr. 2023 Aug 11;11:1239014. doi: 10.3389/fped.2023.1239014. eCollection 2023.
Sepsis is a major cause of mortality and morbidity globally, with around one-quarter of all sepsis-related deaths occurring in children under the age of 5. We conducted a meta-analysis and systematic review of the literature to evaluate the clinical effectiveness of an IgM-enriched immunoglobulin preparation in pediatrics patients and neonates with sepsis.
Systematic searches of PubMed, the Cochrane Library and Embase databases were performed in November 2022, with no date limitations, to identify studies in which IgM-enriched immunoglobulin was used as adjunctive therapy in neonatal and pediatric patients with sepsis.
In total, 15 studies fulfilled the eligibility criteria, 13 neonatal studies and 2 pediatric studies. Pooled estimates from all studies indicated that mortality rates were significantly lower in patients who received treatment with the IgM-enriched immunoglobulin compared with controls (OR 0.41; 95% CI 0.32-0.55). Further analyses in neonatal studies, alone, showed a significant benefit with longer treatment durations (>3 days) vs. the recommended treatment duration (3 days) (OR 0.32; 95% CI 0.22-0.47) vs. (OR 0.61; 95% CI 0.41-0.92). Treatment with IgM-enriched immunoglobulin was associated with a lower mortality risk compared with controls in prospective studies vs. retrospective analyses (OR 0.37; 95% CI 0.27-0.51) vs. (OR 0.73; 95% CI 0.41-1.30).
This systematic review suggests that adjunctive treatment with IgM-enriched immunoglobulin may reduce the risk of mortality in neonatal and pediatric populations. However, large randomized controlled trials are required to further substantiate and evaluate these findings.
脓毒症是全球死亡和发病的主要原因，所有与脓毒症相关的死亡中约四分之一发生在5岁以下儿童。我们对文献进行了荟萃分析和系统评价，以评估富含IgM的免疫球蛋白制剂在儿科患者和脓毒症新生儿中的临床疗效。
2022年11月对PubMed、Cochrane图书馆和Embase数据库进行了系统检索，无日期限制，以确定将富含IgM的免疫球蛋白用作脓毒症新生儿和儿科患者辅助治疗的研究。
共有15项研究符合纳入标准，其中13项为新生儿研究，2项为儿科研究。所有研究的汇总估计表明，与对照组相比，接受富含IgM的免疫球蛋白治疗的患者死亡率显著降低（OR 0.41；95%CI 0.32-0.55）。仅在新生儿研究中的进一步分析显示，较长治疗持续时间（>3天）与推荐治疗持续时间（3天）相比有显著益处（OR 0.32；95%CI 0.22-0.47）与（OR 0.61；95%CI 0.41-0.92）。在前瞻性研究与回顾性分析中，与对照组相比，富含IgM的免疫球蛋白治疗与较低的死亡风险相关（OR 0.37；95%CI 0.27-0.51）与（OR 0.73；95%CI 0.41-1.30）。
本系统评价表明，富含IgM的免疫球蛋白辅助治疗可能降低新生儿和儿科人群的死亡风险。然而，需要大型随机对照试验来进一步证实和评估这些发现。
