Jenson H B, Pollock B H
Department of Pediatrics, University of Texas Health Science Center, San Antonio 78284-7811, USA.
Semin Perinatol. 1998 Feb;22(1):50-63. doi: 10.1016/s0146-0005(98)80007-4.
The use of intravenous immunoglobulin (IVIG) for the prevention and treatment of sepsis in neonates is appealing because of the relative immunodeficiency of the neonate and the desire to improve the relatively poor outcome even with optimal antimicrobial treatment. The effectiveness of IVIG for these uses has been studied in numerous prospective as well as retrospective small and large trials that have had discordant conclusions. Meta-analysis demonstrates the marginal but significant benefit of prophylactic IVIG administered shortly after birth in preventing early onset sepsis in premature low birth weight newborns (P = .0193, two-sided). The expense of prophylactic use of IVIG administration for the relatively large premature newborn population given the minimal benefit as demonstrated by original studies and by meta-analysis is not justified. In contrast, meta-analysis of studies of IVIG for the treatment of neonates with sepsis shows a significant and unequivocal sixfold decrease in the mortality rate (P = .007, two-sided) when IVIG is administered in addition to standard therapies. The additional benefit of decreasing the risk for acute mortality indicates that the inclusion of IVIG should be considered a part of the routine therapy of neonatal sepsis.
由于新生儿相对免疫缺陷，且即便采用最佳抗菌治疗其预后仍相对较差，因此使用静脉注射免疫球蛋白（IVIG）预防和治疗新生儿败血症具有吸引力。众多前瞻性以及回顾性的小型和大型试验对IVIG用于这些用途的有效性进行了研究，但得出的结论并不一致。荟萃分析表明，出生后不久给予预防性IVIG在预防早产低体重新生儿早发型败血症方面有微小但显著的益处（P = 0.0193，双侧）。鉴于原始研究和荟萃分析显示益处极小，对相对庞大的早产新生儿群体预防性使用IVIG的费用是不合理的。相比之下，对IVIG治疗败血症新生儿的研究进行荟萃分析表明，在标准治疗基础上加用IVIG时，死亡率显著且明确地降低了六倍（P = 0.007，双侧）。降低急性死亡风险的额外益处表明，应考虑将IVIG纳入新生儿败血症的常规治疗。
