Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration.
BACKGROUND
The benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial.


OBJECTIVE
To evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections.


METHODS
We retrospectively analyzed 67 neonates with culture-confirmed severe enteroviral infection, defined as hepatitis with coagulopathy and thrombocytopenia. Clinical features, outcomes and the usage of IVIG therapy were collected and analyzed. IVIG administered within 3 days of illness onset was classified as early IVIG therapy.


RESULTS
Of the 67 cases, 38 (57%) were male, 27 (40%) were premature, 57 (85%) had disease onset within 7 days of life and all but 2 cases were caused by coxsackievirus B group. Ten infants (15%) had clinically evident myocarditis. 41 infants (61%) received IVIG therapy and 29 were early IVIG therapy. Fifteen infants (22%) eventually died, without IVIG therapy for 7 infants. The deceased had a significantly higher peak serum aspartate aminotransferase (AST) level than the survivors (3539 vs. 866 IU/L, p<0.01). The timing of IVIG therapy was highly correlated with the timing of peak AST level in patients with early IVIG therapy. Multiple logistic regression analysis showed that a higher nadir hemoglobin level (adjusted odds ratio 2.8, 95% confidence interval: 1.4-5.4), no concurrent myocarditis (42.6 [3.4-5289]) and early IVIG therapy (14.7 [1.3-163]) were independently associated with a favorable prognosis.


CONCLUSIONS
In defined severe neonatal enterovirus infections, serum AST level correlated with the disease severity. Early IVIG therapy, if needed, may be beneficial for survival.
Departments of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University School of Medicine, Taoyuan, Taiwan.
Meng-Hsiu
MH
Yen
Departments of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: ychuang@cgmh.org.tw.
Yhu-Chering
YC
Huang
Biostatistics Consulting Center and Department of Public Health, Chang Gung University School of Medicine, Taoyuan, Taiwan.
Min-Chi
MC
Chen
Department of Pediatrics, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
Ching-Chuan
CC
Liu
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Nan-Chang
NC
Chiu
Departments of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Reyin
R
Lien
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Luan-Yin
LY
Chang
Departments of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Cheng-Hsun
CH
Chiu
Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Kuo-Chien
KC
Tsao
Departments of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: pidlin@cgmh.org.tw.
Tzou-Yien
TY
Lin
D001219:Aspartate Aminotransferases / Q000097:blood; D004769:Enterovirus Infections / Q000401:mortality / Q000628:therapy* / Q000821:virology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006505:Hepatitis; D006801:Humans; D007116:Immunization, Passive; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000627:therapeutic use; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D008297:Male; D009205:Myocarditis; D012189:Retrospective Studies; D013921:Thrombocytopenia; D061665:Time-to-Treatment; D016896:Treatment Outcome
D006454:Hemoglobins; D016756:Immunoglobulins, Intravenous; D001219:Aspartate Aminotransferases
Enterovirus; Hepatitis; Intravenous immunoglobulin; Myocarditis; Neonates