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

doi:10.5409/wjcp.v15.i2.118421

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Jun 9, 2026 (publication date) through May 16, 2026

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World Journal of Clinical Pediatrics

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2219-2808

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Pediatr. Jun 9, 2026; 15(2): 118421
Published online Jun 9, 2026. doi: 10.5409/wjcp.v15.i2.118421

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

Poovazhagi Varadarajan, Seenivasan Subramani, Vasanth Jeyaram, Lakshmi S Velmurugan, Raghul Jayaseelan, Gomathy Srividya Venugopal

Poovazhagi Varadarajan, Seenivasan Subramani, Vasanth Jeyaram, Lakshmi S Velmurugan, Raghul Jayaseelan, Gomathy Srividya Venugopal, Department of Pediatric Intensive Care, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai 600008, Tamil Nādu, India

Author contributions: Varadarajan P, Subramani S, Jeyaram V contributed to the study conception and design; Velmurugan LS, Jayaseelan R and Venugopal GS performed material preparation, data collection, and data analysis; Varadarajan P, Subramani S wrote the manuscript draft and its revisions, with all authors providing feedback on all versions; and all the authors approved the final manuscript.

Institutional review board statement: The study was reviewed and approved by the Madras Medical College, Institutional Review Board (Approval No. 04032025).

Informed consent statement: Consent from parents/care givers was waived by ethics committee as it was data collection from the patient file registry system of the unit.

Conflict-of-interest statement: We have no financial relationships to disclose.

STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.

Data sharing statement: No additional data are available.

Corresponding author: Seenivasan Subramani, DM, Assistant Professor, Consultant, Department of Pediatric Intensive Care, Institute of Child Health and Hospital for Children, Madras Medical College, Tamil Salai, Egmore, Chennai 600008, Tamil Nādu, India. seeni.sholing@gmail.com

Received: January 7, 2026
Revised: January 29, 2026
Accepted: February 13, 2026
Published online: June 9, 2026
Processing time: 128 Days and 1.6 Hours

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%.

Keywords: Intravenous immunoglobulin; Pediatric intensive care unit; Off label use; Strength of recommendation; Level of evidence

Core Tip: This study evaluates intravenous immunoglobulin (IVIG) use in a pediatric intensive care unit, highlighting indications, dosing, evidence support, and outcomes. The commonest indication was immunological diseases followed by neurological illness, infections, hematological diseases and cardiac diseases. Strength of recommendation varies in different diseases. Off label use was seen in about one -fifth of patients. Adverse effects were minimal. Evidence is lacking regarding the use of IVIG in many diseases. The study suggests multicentric trials to define proper indications of IVIG.