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Iowa Neonatology Handbook: Infection
Tolerance of IVIG Administration to Neonates
Chetan A. Patel MD and Edward F. Bell, MD
Peer Review Status: Internally Peer
Reviewed
IVIG should be administered by itself, with careful monitoring
during the infusion. Vital signs should be monitored during the
infusion (preferably q 15 min. X 2, then q hr). In the large
multicenter trials involving infants, very few adverse reactions were
noted during infusion. These consisted of mild increases or decreases
in blood pressure, heart rate, or temperature (that were reversed by
slowing the rate of infusion) or acute fluid overload. Since the dose
of IVIG is equivalent to an approximately 10 ml/kg fluid bolus, the
infusion is administered over several (typically 3 - 4) hours.
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Brand name
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Form
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Characteristics
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Reconstituted In
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Cautions
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Gammagard® (Baxter)
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0.5, 2.5, 5 and 10 g vials
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pH 6.8, 2% glucose, 0.3% albumin
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Sterile Water
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Rate dependent side effects on HR, BP, Temperature
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Gamimune N® (Miles-Cutter)
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5% solutions (Premixed)
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pH 4.25.
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10% maltose (For Isotonicity)
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Above; Hyperglycemia, and rare decreased pH
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Sandoglobulin (Sandoz)
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1, 3, and 6 g vials
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pH 6.6, 5 or 10% sucrose (1.67 g)
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0.9% NaCl, D5W, or sterile water
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Above, Hyperglycemia
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References:
Jensen HB, Pollock BH. Meta-analysis of the effectiveness of
intravenous immunoglobulin for prevention and treatment of neonatal
sepsis. Pediatrics, 1997; 99:E2.
Baker CJ, Melish ME, Hall RT, et al. Intravenous immune globulin
for the prevention of nosocomial infection in low-birth-weight
neonates. N Engl J Med 1992; 327:213-9.
Fanaroff AF, Korones SB, Wright LL, et al. A controlled trial of
intravenous immune globulin to reduce nosocomial infections in VLBW
infants. N Engl J Med 1994; 330:1107-1113.
Kliegman RM and Clapp DW. Rational principles for immunoglobulin
prophylaxis and therapy of neonatal infections. Clin Perinatol 1991;
18:303-24.
Weisman LE, Stoll BJ, Keuser TJ, et al. Intravenous immune
globulin therapy for early-onset sepsis in premature neonates J
Pediatr 1992; 121:434-43.
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