Intravenous immune globulin prophylaxis of late-onset sepsis in premature neonates.

To determine whether a single dose of intravenously administered immune globulin (IVIG) decreases late-onset sepsis in premature infants, we prospectively entered 753 neonates with birth weight 500 to 2000 gm, gestation < or = 34 weeks, and age < or = 12 hours into a multicenter, double-blind, controlled trial. Infants were randomly selected to receive a single intravenous infusion, 10 ml/kg, of either IVIG (500 mg/kg) or albumin (5 mg/kg) and were observed for 8 weeks for infection. Maternal and neonatal risk factors for infection did not differ between groups. Although serum IgG values before infusion were related to gestation (R = 0.62), the change in serum IgG or half-life of IgG after IVIG infusion was not (R < or = 0.09). The serum IgG concentration was increased (p < 0.05) in IVIG-treated patients for 8 weeks. There were 88 episodes of late-onset sepsis in 79 neonates (10.5%). Causative organisms included the following: Staphylococcus epidermidis (37 episodes), Enterococcus (9), Staphylococcus aureus (7), Candida (6), Escherichia coli (6), and multiple organisms (11). Sepsis, death, and death as a result of infection were unaffected by treatment. We conclude that a single infusion of IVIG, 500 mg/kg, shortly after birth was not effective prophylaxis for late-onset infection in premature neonates. Future studies of late-onset sepsis prophylaxis should consider IVIG with known pathogen-specific antibody concentrations against organisms causing these infections, in particular S. epidermidis.

Intravenous immune globulin therapy for early-onset sepsis in premature neonates.

Newborn infants may have IgG deficiencies that increase their susceptibility to bacterial infection. To determine whether intravenous immune globulin (IVIG) therapy improves survival rates in early-onset sepsis, we prospectively entered 753 neonates (birth weight 500 to 2000 gm, gestation less than or equal to 34 weeks, age less than or equal to 12 hours) into a multicenter, double-blind, controlled trial. Blood culture specimens were obtained and infants randomly assigned to receive 10 ml (per kilogram) intravenously of a selected IVIG (500 mg/kg) or albumin (5 mg/kg) preparation. Maternal and neonatal risk factors were not different between groups. Thirty-one babies (4.2%) had early-onset sepsis; the causative organisms were group B streptococcus (12 babies), Escherichia coli (6), and others (13). Of these 31 neonates, 7 (23%) died. Total serum IgG was higher for 7 days after IVIG therapy than after albumin treatment (p less than 0.05). During these 7 days, 5 (30%) of 17 albumin-treated and none of 14 IVIG-treated patients died (p less than 0.05). The survival rate at 56 days of age, however, was not significantly improved. Group B streptococcus type-specific IgG antibody was significantly increased after IVIG treatment and appeared to be related to the amount of IVIG specific antibody. Infusion-related adverse reactions were less frequent in patients receiving IVIG therapy (0.5%) than in those receiving albumin. The IVIG therapy in neonates with early-onset sepsis, while reducing the early mortality rate, did not significantly affect the overall survival rate. Further studies are necessary to confirm these findings and to determine more effective therapeutic regimens.

Twins and triplets with necrotizing enterocolitis.

We reviewed 2856 multiple-gestation pregnancies from 1980 to 1985 to identify whether birth order or other features (eg, asphyxia) were significant risk factors for the development of necrotizing enterocolitis (NEC). There were 42 infants identified as having NEC from 30 pairs of twins and three sets of triplets. The firstborn was diagnosed with NEC in 19 (45%) of the cases, with the disorder occurring in the secondborn in 23 cases (55%). While infants A and B were simultaneously affected in nine cases, among the three sets of triplets, no thirdborn infants developed NEC. Although the secondborn infants had significantly lower one-minute Apgar scores and a more frequent need for resuscitation, they were no more prone to develop NEC than were firstborn infants. Multiple gestation, birth order, feeding practices, and a number of other features we evaluated were not associated with the development of NEC. Our findings support the contention that prematurity is the only consistent risk factor in the development of NEC.

Declining frequency of circumcision: implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy.

The results of an investigation examining the circumcision frequency rate and its effect on the incidence of urinary tract infections in a large, widely dispersed population base during the 10-year period since the 1975 report of the American Academy of Pediatrics Ad Hoc Task Force on Circumcision are reported. Our study population included the 427,698 infants born in all United States Army hospitals, worldwide, from Jan 1, 1975, through Dec 31, 1984. There was an initial plateau in the circumcision frequency rate at approximately 85% during the first 4 years of the study period. In the subsequent 6 years there was a steady, significant decrease (P less than .001) of 1.4% to 4.0% per year through 1984, when the circumcision frequency rate reached its nadir of 70.5%. There was a concomitant increase in the total number of urinary tract infections among male infants (P less than .02) as the circumcision rate declined. This increase was due to the increase in the overall number of uncircumcised boys (who had a greater than 11-fold increased infection rate compared with circumcised boys). During the first half of the study period, there was a female predominance for urinary tract infections from birth onward. As the number of circumcised boys decreased (with a resultant increase in the total number of boys with infection), the male to female ratio of urinary tract infections during the first 3 months of life reversed, reflecting a movement toward a male predominance for infection in early infancy. This is the first, well-documented report of a decreasing rate of circumcisions performed on the American male population.(ABSTRACT TRUNCATED AT 250 WORDS)