Clinical efficacy of IgM-enriched immunoglobulin as adjunctive therapy in neonatal and pediatric sepsis: a systematic review and meta-analysis

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DİNLEYİCİ E. Ç., Frey G., Kola E., Wippermann U., Bauhofer A., Staus A., ...Daha Fazla

FRONTIERS IN PEDIATRICS, cilt.11, 2023 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 11
  • Basım Tarihi: 2023
  • Doi Numarası: 10.3389/fped.2023.1239014
  • Dergi Adı: FRONTIERS IN PEDIATRICS
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, Directory of Open Access Journals
  • Anahtar Kelimeler: IgM-enriched immunoglobulin, neonate, pediatric, sepsis, mortality, infection, meta-analysis, GAMMA-GLOBULIN LEVELS, BIRTH-WEIGHT INFANTS, INTRAVENOUS IMMUNOGLOBULIN, SEPTIC SHOCK, POLYCLONAL IMMUNOGLOBULINS, B-CELLS, MORTALITY, SURVIVAL, EPIDEMIOLOGY, ANTIBODIES
  • Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

Background: Sepsis is a major cause of mortality and morbidity globally, with around one-quarter of all sepsis-related deaths occurring in children under the age of 5. We conducted a meta-analysis and systematic review of the literature to evaluate the clinical effectiveness of an IgM-enriched immunoglobulin preparation in pediatrics patients and neonates with sepsis.Methods: Systematic searches of PubMed, the Cochrane Library and Embase databases were performed in November 2022, with no date limitations, to identify studies in which IgM-enriched immunoglobulin was used as adjunctive therapy in neonatal and pediatric patients with sepsis.Results: In total, 15 studies fulfilled the eligibility criteria, 13 neonatal studies and 2 pediatric studies. Pooled estimates from all studies indicated that mortality rates were significantly lower in patients who received treatment with the IgM-enriched immunoglobulin compared with controls (OR 0.41; 95% CI 0.32-0.55). Further analyses in neonatal studies, alone, showed a significant benefit with longer treatment durations (>3 days) vs. the recommended treatment duration (3 days) (OR 0.32; 95% CI 0.22-0.47) vs. (OR 0.61; 95% CI 0.41-0.92). Treatment with IgM-enriched immunoglobulin was associated with a lower mortality risk compared with controls in prospective studies vs. retrospective analyses (OR 0.37; 95% CI 0.27-0.51) vs. (OR 0.73; 95% CI 0.41-1.30).Conclusions: This systematic review suggests that adjunctive treatment with IgM-enriched immunoglobulin may reduce the risk of mortality in neonatal and pediatric populations. However, large randomized controlled trials are required to further substantiate and evaluate these findings.