|Title:||Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration||Authors:||Yen M.-H.
|Keywords:||Enterovirus; Hepatitis; Intravenous immunoglobulin; Myocarditis; Neonates||Issue Date:||2015||Publisher:||Elsevier||Journal Volume:||64||Start page/Pages:||92-96||Source:||Journal of Clinical Virology||Abstract:||
Background: The benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial. Object: To evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections. Study designs: 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. ? 2015 Elsevier B.V.
|ISSN:||1386-6532||DOI:||10.1016/j.jcv.2015.01.013||SDG/Keyword:||aspartate aminotransferase; bilirubin; hepatitis B antibody; immunoglobulin; aspartate aminotransferase; hemoglobin; immunoglobulin; Article; aspartate aminotransferase blood level; bilirubin blood level; blood clotting disorder; body temperature; clinical feature; Coxsackie virus B; disease severity; Enterovirus infection; female; hemoglobin blood level; hepatitis; human; leukocyte count; major clinical study; male; myocarditis; newborn; newborn infection; newborn sepsis; onset age; outcome assessment; partial thromboplastin time; prematurity; priority journal; prothrombin time; retrospective study; thrombocytopenia; blood; Enterovirus Infections; mortality; newborn disease; passive immunization; time to treatment; treatment outcome; virology; Aspartate Aminotransferases; Enterovirus Infections; Female; Hemoglobins; Hepatitis; Humans; Immunization, Passive; Immunoglobulins, Intravenous; Infant, Newborn; Infant, Newborn, Diseases; Male; Myocarditis; Retrospective Studies; Thrombocytopenia; Time-to-Treatment; Treatment Outcome
|Appears in Collections:||醫學系|
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