Intravenous immunoglobulin in the prevention and treatment of neonatal bacterial sepsis.

IVIG has been shown in vitro to enhance many antibody-dependent immunologic functions. In animal models, IVIG enhanced the survival of septic neonates. In humans, preliminary data indicate that prophylactic IVIG may diminish the incidence of bacterial sepsis in VLBW neonates if sufficient doses of the immunoglobulin are administered repeatedly. IVIG administered after the onset of clinical symptoms may improve the survival of septic human neonates. However, the studies designed to assess the efficacy of IVIG to treat established sepsis have employed a small number of subjects and have, overall, provided inconclusive data. IVIG has been tolerated well by neonates, but the safety and long-term consequences of administering IVIG to newborn infants are not yet defined. IVIG will likely serve as a useful adjunct to enhance the antibacterial defenses of newborn infants. Use of IVIG in human neonates remains experimental at this time; therefore, the clinical application of IVIG for the prevention or treatment of neonatal bacterial sepsis should await the development of guidelines to be derived from ongoing multicentered, placebo-controlled clinical trials.