Intravenous Immunoglobulin Use in Pediatric Intensive Care: A Single-Center Experience

Abstract

Abstract Purpose: The clinical applications of intravenous immunoglobulin (IVIG) therapy in critically ill children are increasing. Here we share our single-center experience with the use of IVIG in the pediatric intensive care unit (PICU). Methods: This retrospective study included patients treated with at least one dose of IVIG in the PICU between November 2019 and April 2022. Results: A total of 68 patients (44 males) were included in the study. The most common indications for IVIG were rheumatologic (43%), infectious (34%), and neurological diseases (14.5%). Twenty-one patients (30%) died. The frequency of chronic disease was 28% among survivors and 76% among non-survivors (p=0.0001). The indication for IVIG was septic shock in 71% of non-survivors (p=0.0001) and multisystem inflammatory syndrome in children in 57% of survivors (p=0.0001). Non-surviving patients had lower median IVIG dose per actual body weight (0.5 vs. 1 g/kg, p=0.02) and cumulative IVIG dose (30 vs. 60 g, p=0.04). In multivariate logistic regression analysis to determine mortality predictors in patients using IVIG, the presence of chronic disease was found to strongly increase mortality (odds ratio: 5.7, 95% confidence interval: 1.5-21, p=0.01). IVIG-related parameters (body weight, number of IVIG doses, cumulative IVIG dose) were not predictors of mortality (p>0.05). Conclusions: Although we observed that the surviving patients in our study received more IVIG than non-survivors, the amount of IVIG was not found to be associated with mortality.