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  • Letter to the Editor
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Response to Buenz and Howe

Journal of Perinatology volume 27, page 197 (2007)Cite this article

Buenz and Howe raise a very important point concerning the administration of intravenous immunoglobulin (IVIg) to neonates. Indeed, children with idiopathic thrombocytopenic purpura that receive IVIg can have a fall in circulating neutrophil concentration due to accelerated neutrophil clearance. Although this mechanism has not been described in neonates after IVIg administration, a somewhat similar occurrence was seen by Lassiter et al.,1 who reported neutropenia in a preterm neonate after IVIg administration, and later identified anti-neutrophil antibodies in the IVIg preparation.

Like any pharmaceutical or biological treatment employed in the neonatal intensive care unit, IVIg should be administered only when it is reasonably certain that the benefits will outweigh the risks. Septic, neutropenic neonates generally lack opsonic antibody to organisms with which they are infected.2 Furthermore, supplying IVIg to septic, neutropenic neonates can improve their capacity to opsonize the organisms with which they are infected and can actually increase their circulating neutrophil concentrations.3, 4 Nevertheless, we completely agree with the caution expressed by Buenze and Howe, regarding administering IVIg to neonates who have a low likelihood of infection. A temporary neutropenia, due to increased clearance of circulating neutrophils, could indeed be a consequence of some such administrations. Thus, if IVIg is to be used as a source of potential opsonins for neonates with overwhelming sepsis,2 it should be done with the cognizance that one possible risk could, theoretically, be a prolongation of the neutropenia owing to IVIg-induced accelerated neutrophil clearance.

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References

  1. Lassiter HA, Bibb KW, Bertolone SJ, Patel CC, Stroneck DFR . Neonatal immune neutropenia following the administration of intravenous immune globulin. Am J Pediatr Hematol Oncol 1993; 15: 120–123.

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  3. Christensen RD, Brown MS, Hall DC, Lassiter HA, Hill HR . Effect on neutrophil kinetics and serum opsonic capacity of intravenous administration of immune globulin to neonates with clinical signs of early-onset sepsis. J Pediatr 1991; 118: 606–614.

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  1. Neonatology, Intermountain Healthcare, 4403 Harrison Blvd, Ogden, 84403, UT, USA

    R Christensen

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Christensen, R. Response to Buenz and Howe. J Perinatol 27, 197 (2007). https://doi.org/10.1038/sj.jp.7211661

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