title: Role of immunoglobulin supplementation for secondary immunodeficiency associated with chylothorax after pediatric cardiothoracic surgery.
abstract: OBJECTIVE
  To evaluate whether intravenous immunoglobulin was linked to a reduction in sepsis in patients with prolonged chylothoraces postpediatric cardiothoracic surgery.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Tertiary pediatric cardiac surgical center.
  
  
  METHODS
  Children with chylothoraces postcardiothoracic surgery from 1998 to 2006 divided into two groups: with and without intravenous immunoglobulin supplementation.
  
  
  METHODS
  Intravenous immunoglobulin supplementation.
  
  
  RESULTS
  Thirty-seven with chylothoraces (median duration 14 days; interquartile range, 10-32 and median maximum chyle drainage 1.9 mL/kg/hr; interquartile range, 1-3) were included, and 16 (43%) received intravenous immunoglobulin. The degree of lymphopenia was worse with longer duration of chylothorax (p = .005). There was a trend toward immunoglobulin depletion-IgG (p = .07) and IgM (p = .07) with higher volume chyle loss. Twenty-two of 37 (59%) developed bloodstream infection and 24 of 37 (65%) developed sepsis related to other organ systems. The rate of bloodstream infection and of sepsis in other organ systems was high at 25 (95% confidence interval 17-39) and 23 (95% confidence interval 15-34) episodes per 1,000 intensive care unit days, respectively. Intravenous immunoglobulin was not related to the bloodstream infection rate: adjusted hazard ratio 0.88 (95% confidence interval 0.20-3.94; p = .87) or rate of sepsis in other organ systems: hazard ratio 2.31 (95% confidence interval 0.21-24.29; p = .49) or the proportion surviving to hospital discharge (p = .37).
  
  
  CONCLUSIONS
  Patients with prolonged, large-volume chyle loss had greater secondary immunodeficiency. Although the sample size was small and therefore able to detect only a large treatment effect from intravenous immunoglobulin, infectious outcomes were equal between the two groups.
authors: Cardiac Critical Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK. hoskoa@gosh.nhs.uk
authors: Aparna U
authors: AU
authors: Hoskote
authors: Raghu N
authors: RN
authors: Ramaiah
authors: Catherine M
authors: CM
authors: Cale
authors: John C
authors: JC
authors: Hartley
authors: Katherine L
authors: KL
authors: Brown
mesh_terms: D000206:Actuarial Analysis; D002916:Chylothorax / Q000150:complications / Q000276:immunology*; D004322:Drainage; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D017099:IgG Deficiency / Q000209:etiology; D007075:Immunoglobulin M / Q000172:deficiency; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007231:Infant, Newborn; D016015:Logistic Models; D008231:Lymphopenia / Q000209:etiology; D011183:Postoperative Complications / Q000276:immunology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index
chemical_list: D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors