Treatment of neonatal sepsis with intravenous immune globulin

Peter Brocklehurst, B Farrell, A King, E Juszczak, B Darlow, K Haque, Alison Salt, Ben Stenson, William Tarnow-Mordi, S Brearley, A Leslie, J Stephenson, D Ashby, F Cockburn, A Grant, B McClelland, Neil Modi, H Thornton, D Altman, R CookeS Dobson, B Greene, G Greisen, T Neal, F Pradhan, B Walden, R Williams, N Armstrong, S Ayers, P Baker, U Bowler, B Catterall, V Cavendish, C Chan-Fook, M Duxbury, D Evans, S Gates, D Hawcutt, M Logan, H McElroy, P Mohan, E Morgan-Jones, J Notman, M Redshaw, C Shakeshaft, C Stevens, S Williams, R Zhao, W Hague, D Henderson-Smart, David Isaacs, John Simes, L Sebastian, R Barsenbach, J Blanco, C Brown, A Cust, P Duggal-Berri, V Gebski, M Hay, L O'Regan, A Pillai, K Mann, A Martin, S Sitha, C van Host Pellekaan, E Abalos, B Carroli, G Carroli, R Rizzi, Y Sguassero, R Garcia, A Raineri, O Falco, F Redondo, M Farri, S Funes, C Burgaretta, L Ramirez, F Fernandez, L Levinson, E Agudo, M Bisbal, M Guerrero, E Szyld, G Brazda, C Deguer, J Ceriani Cernadas, V Cravedi, A Leyton, A Prado, D Rodrigue, N Herrera, M Murad, J Aguirre, S Arosio, C Picon, N Posse, S Rolon, P Vacou, C Buking, C Soto Conti, M Deckert, M Kronemberger, I Navarro, M Turturici, E Collino, A Peyrano, N Bouceau, M Bruni, L Parga, D Varela, P Sachetti, M Alem, H Camusso, A Oviedo, P Ponce de Leon, Rafael Diaz, J Morante, G Puig, M del Barco, M Filtrin, F Oliveira, E Halac, G Alberto, S Meskell, G Reynolds, P Craven, L Hobson, K Meredith, C Chambers, J Phelps, Scott Morris, J Buchan, R Glover, J Sarunac, R Guaran, N Pazanin, J Stack, D Casalaz, S Saker, D Wilson, M Hayes, H Kopp, T Lewis, H Coughtrey, K Davies, L Simeon, D Cartwright, G Hermann, M Pritchard, John Mills, L Perkins, C Plover, K Butterley, Peter Dargaville, G Ryan, I Graudins, K Lui, J Michalowski, M Gibson, M Jeffrey, M Klucklow, N Evans, J Hay, S Reid, K Callanan, L Doyle, S Wong, P Fa, M Luig, B Twible, V Bhatia, Louise Goodchild, K Western, V Cossey, M Dahl, J Reinholdt, B Hoest, L Vad Pedersen, H Dellagrammaticas, N Iacovidou, L Bradfield, B Murphy, C Ryan, M Gojic, B Vasiljevic, N McNeill, D Pugh-Williams, R Broadbent, F McCaffrey, O Johnson, T Bushell, J L'Anson, M Wong, Malcolm Battin, K Anderson-Hawke, A Kennedy, J Brown, P Kumar, S Butler, A Hale, D Harris, D Elder, M Gibson, S Bali, A Cubitt, L Jones, O Rackham, E Macrae, J Staines, S Konig, E Wong, F Marshall, M Saeed, C Maybor, S Rose, S Chatfield, S Szpara, L Elliott, T Soe, J Nycyk, M Perry, D Freeman, D Rogahn, H Kirby, J Madar, P Adiotomre, J Watkinson, N Al Hilaly, V Wijetunge, J Simpson, R Wakefield, S Ainsworth, K McCormack, M Peters, H Tighe, M Cruwys, M Hoong, E Crosbie, A Knapton, M Lal, B Whalley, H Pentelow, P Rao, H Doyle, P Sivakumar, J Chang, S Lam, B Jani, G West, D Kirby, B Kumararatne, V Gopinathan, D Irving, S Hendry, M Ibrahim, A McGahon, R Nicholl, C Campbell, J Dorling, R Cousins, H Kisat, R Rao, D Sheehy, J Brazier, R Thambapillai, A Powls, S Provan, P Fox, S Rubin, W Barry, L Handley, J Henwood, E Murdoch, R Bhadoria, C Shoilan, M Lama, S Shahili, K Afshar, M Yadav, P Munyard, P Nichols, A Collinson, H Mill, I Al-Muzaffar, M Fernandez, J McCormick, K McCullagh, D Sweet, S Deshpande, M Taplin, L Barrow, C Lawn, J Cousins, A Pike, R Shephard, C Speirs, A Emmerson, J Mercy, C Groves, A Jain, C Waite, T Otunla, M Woodford, R Arya, M Qasim, S Sivashankar, S Armstrong, R Coombs, D Garvie, S Holmes, A Gupta, J Bradshaw, P Satodia, A Glennard, R Webb, J Frost, N Wilson, D Long, S O'Brien, S Ibhanesebhor, A McManus, A Garg, G Triance, J Blades, M Russell-Taylor, L Bowden, R O'Brien

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    183 Citations (Scopus)

    Abstract

    BACKGROUND: Neonatal sepsis is a major cause of death and complications despite antibiotic treatment. Effective adjunctive treatments are needed. Newborn infants are relatively deficient in endogenous immunoglobulin. Meta-analyses of trials of intravenous immune globulin for suspected or proven neonatal sepsis suggest a reduced rate of death from any cause, but the trials have been small and have varied in quality. METHODS: At 113 hospitals in nine countries, we enrolled 3493 infants receiving antibiotics for suspected or proven serious infection and randomly assigned them to receive two infusions of either polyvalent IgG immune globulin (at a dose of 500 mg per kilogram of body weight) or matching placebo 48 hours apart. The primary outcome was death or major disability at the age of 2 years. RESULTS: There was no significant between-group difference in the rates of the primary outcome, which occurred in 686 of 1759 infants (39.0%) who received intravenous immune globulin and in 677 of 1734 infants (39.0%) who received placebo (relative risk, 1.00; 95% confidence interval, 0.92 to 1.08). Similarly, there were no significant differences in the rates of secondary outcomes, including the incidence of subsequent sepsis episodes. In follow-up of 2-year-old infants, there were no significant differences in the rates of major or nonmajor disability or of adverse events. CONCLUSIONS: Therapy with intravenous immune globulin had no effect on the outcomes of suspected or proven neonatal sepsis. (Funded by the United Kingdom Medical Research Council and others; INIS Current Controlled Trials number, ISRCTN94984750.).

    Original languageEnglish
    Pages (from-to)1201-1211
    Number of pages11
    JournalNew England Journal of Medicine
    Volume365
    Issue number13
    DOIs
    Publication statusPublished - 2011

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