Adjuvant use of intravenous immunoglobulin in the treatment of neonatal sepsis: a systematic review with a meta-analysis.

Objective: To evaluate whether intravenous immunoglobulin reduces mortality and length of hospital stay in the treatment of neonatal sepsis.

Sources: The MEDLINE database was searched. The keywords were combined using the following search strategy: [(sepsis OR shock, septic OR infection) AND immunoglobulins, intravenous] AND infant, newborn. Only randomized clinical trials (RCTs) showing good methodological quality and assessing the effect of adjuvant intravenous immunoglobulin in the treatment of neonatal sepsis were selected for inclusion and data analysis.

Summary Of The Findings: Seven RCTs were selected. All of them evaluated the mortality rate, including 3,756 patients. The global effect of this outcome showed no statistically significant difference between the groups. Only five studies evaluated the mean length of hospital stay, including 3,672 patients. Although there is a statistically significant reduction of 1.24 days in the length of hospital stay with the use of intravenous immunoglobulin, such difference is clinically irrelevant and its high cost does not warrant its routine use in medical practice. The data reported in the present review contradict the review by Ohlsson et al., which was updated in 2010 and showed significant benefit with the use of intravenous immunoglobulin on both outcomes.

Conclusions: We concluded that the use of adjuvant intravenous immunoglobulin shows no benefit regarding mortality, whereas the reduction in the length of hospital stay is irrelevant.