Exchange transfusion or intravenous immunoglobulin therapy as an adjunct to antibiotics for neonatal sepsis in developing countries: a pilot study

Both intravenous administration of immunglobulin (IVIG) and exchange transfusion (ET) have been used for treatment of neonatal sepsis. No studies have compared ET with IVIG in neonates. Aim: The aim of the study was to investigate serial IgG and IgM serum levels in two groups of septic infants treated with either IVIG or ET as adjuvant therapy. Results: A total of 88 infants with sepsis and gestational ages ranging from 32 to < 37 weeks were enrolled consecutively. The effect of ET with fresh, whole blood and IVIG on immunoglobulin G and M levels was monitored over a 24-hour period. ET was performed on 33 infants, 33 infants received IVIG and 22 infants served as controls. There were nine deaths (27%) in the IVIG group, seven (21%) in the ET group and nine (41%) in the control group (p > 0.05). IgG levels rose significantly 12 hours after administration of IVIG (p < 0.01). There were no differences between the initial and 24-hour IgG levels in the WIG group. IgG levels did not change significantly in the ET and control groups. IgM levels rose significantly 12 hours after ET and elevated IgM levels persisted for over 24 hours.