Fischer G W
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814.
Clin Exp Immunol. 1994 Jul;97 Suppl 1(Suppl 1):73-7.
Bacterial infections remain a major cause of morbidity and mortality in neonates. Intravenous immune globulin (IVIG) may enhance immunity to neonatal bacterial pathogens by facilitating opsonophagocytosis. In early-onset neonatal sepsis, antibody has improved survival when used therapeutically in combination with antibiotics. However, some IVIG lots may not contain sufficient pathogen-specific antibody to provide effective therapy. Antibody prophylaxis has not provided protection from late-onset (nosocomial) sepsis consistently. Failure of antibody prophylaxis may also be related to variable levels of opsonic antibodies to nosocomial bacteria in IVIG preparations. Staphylococci (particularly Staphylococcus epidermidis) have become a major cause of late-onset sepsis. IVIG preparations contain variable levels of antibody to S. epidermidis, with many lots having nearly undetectable anti-staphylococcal antibody titres. This absence of antibodies to staphylococci may explain why antibody prophylaxis of neonatal sepsis has not been consistently effective. In future studies, IVIG preparations or monoclonal antibodies that possess specific antibodies to key neonatal pathogens will be needed.
细菌感染仍然是新生儿发病和死亡的主要原因。静脉注射免疫球蛋白（IVIG）可通过促进调理吞噬作用增强对新生儿细菌病原体的免疫力。在早发型新生儿败血症中，抗体与抗生素联合使用时可提高生存率。然而，一些IVIG批次可能不含足够的病原体特异性抗体以提供有效治疗。抗体预防并不能始终预防晚发型（医院获得性）败血症。抗体预防失败也可能与IVIG制剂中针对医院细菌的调理抗体水平不同有关。葡萄球菌（尤其是表皮葡萄球菌）已成为晚发型败血症的主要原因。IVIG制剂中针对表皮葡萄球菌的抗体水平各不相同，许多批次的抗葡萄球菌抗体滴度几乎检测不到。缺乏针对葡萄球菌的抗体可能解释了为什么新生儿败血症的抗体预防并非始终有效。在未来的研究中，将需要具有针对关键新生儿病原体的特异性抗体的IVIG制剂或单克隆抗体。
