Abstract
Introduction: THI is a defect in a child's endogenous immunoglobulin production. It presents early following the physiological catabolism of the remnants of maternal immunoglobulin, transferred trans-placentally during the course of pregnancy. Physiological hypogammaglobulinemia normalises by 2-4 months. However during prolonged THI; the infant is rendered susceptible to a range of bacterial infections. In severe cases intravenous immunoglobulin-G (IV-IgG) replacement therapy has been proposed as treatment.
Objectives: To analyse current experimental literature in order to assess the suitability of IVIgG therapy for patients diagnosed with suspected THI. Assessment of therapeutic use of IV-IgG from retrospective case controls. Further qualification of when to use IV-IgG by assessment of additional factors: symptomatology, time to normalisation of immunoglobulins and comparison with other immunodeficiency syndromes.
Methods: PubMed - searched with MeSH term “hypogammaglobulinemia”; “transient hypogammaglobulinemia infancy”, “hypogammaglobulinemia IVIg”, “paediatric hypogammaglobulinaemia”.
Results: Antibiotics are first-line treatment for recurrent infections. IV-IgG replacement therapy is not routinely warranted for symptomatic THI. Cases where infections are severe/resistant to conventional management, IV-IgG therapy can be considered.
Other primary immunodeficiencies requiring IVIG therapy present similarly to THI as recurrent infections. In contrast THI is self-resolving with a benign clinical progression if managed appropriately;
Conclusion: Most children with THI do not require IV-IgG, with the exception of severe life-threatening infections or ongoing bacterial respiratory infection despite prophylactic antibiotic therapy. In these circumstances trials of IV-IgG for 6-12 months are indicated.
There are no published studies that comprehensively assess the cost-effectiveness of IV-IgG replacement in any healthcare setting for THI.
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Xiu, P., Ledingham, D., Masand, S. et al. 881 In Infants with An Initial Diagnosis of Transient Hypogammaglobulinemia of Infancy (THI), is the Use of IV Immunoglobulin Warranted?. Pediatr Res 68 (Suppl 1), 442 (2010). https://doi.org/10.1203/00006450-201011001-00881
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DOI: https://doi.org/10.1203/00006450-201011001-00881
