Study on intravenous immunoglobulin use in a pediatric intensive care unit of a tertiary care center.

Abstract

Background: Intravenous immunoglobulin (IVIG), an immunomodulatory therapy/agent has been increasingly used and its off label use is on the rise in critical care units. We planned to analyze the indications of IVIG in different disease conditions in pediatric intensive care unit (PICU). This is a single- center ambispective audit on IVIG use.

Aim: To study the usage pattern of IVIG among children admitted at a pediatric tertiary care unit.

Methods: This was an ambispective study in which data was collected retrospectively from January 2021 to February 2025 and prospectively from March 2025 to November 2025 in a PICU of a tertiary care center. Details of age, sex, indications, strength of recommendation and survival in each disease group were documented.

Results: Four hundred and fifty five children received IVIG during the study period. The commonest indication was immunological diseases (42.4%, n = 193), followed by neurological illness (33.6%, n = 153), infections (13.19%, n = 60), hematological diseases (9.2%, n = 42) and cardiac diseases (all acute myocarditis) (1.5%, n = 7). Use of IVIG as per strength of recommendation A, B, C, D were 89 (19.5%), 176 (38.5%), 92 (20.2%) and 98 (21.5%) respectively. Overall mortality was 22.42% (n = 102). The off label usage of IVIG in the unit was 21.5%.

Conclusion: IVIG was commonly used in immunological and neurological diseases in our cohort. 78.5% received IVIG as per strength of recommendation A, B, C. Off label use was 21.5%.