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

Table 1 Neurological and infectious indications, outcomes, and evidence for intravenous immunoglobulin use, n (%)

Condition (% of total)	Received IVIG	Survived	Recommendation	Evidence	Strength
Neurological (33.6)	153	123 (80.4)
AES	38	26 (68.4)	No	III	D
ADEM	9	9 (100)	No	IIb	C
ALERD	2	2 (100)	No	III	C
ANEC	5	4 (80)	No	III	C
FIRES	11	7 (63.6)	No	II	C
Guillain-Barré syndrome	68	57 (83.8)	Yes	Ib	A
Myasthenia gravis	1	1 (100)	No	Ib	B
Autoimmune encephalitis	19	17 (89.5)	No	II	C
Infections (13.2)	60	40 (66.7)
Dengue encephalitis	32	25 (78.1)	No	IV	D
Dengue MODS/cytokine storm	12	7 (58.3)	No	IV	D
Disseminated adenovirus infection	14	7 (50)	No	IV	D
Mycoplasma encephalitis/SE	2	1 (50)	No	IV	D

Categorization of evidence and basis of recommendation Ia from meta-analysis of randomized controlled studies, Ib from at least one randomized controlled study, IIa from at least one controlled trial without randomization, IIb from at least one other type of quasi-experimental study, III From nonexperimental descriptive studies, such as comparative, correlation, or case-control studies, IV From expert committee reports or opinions or clinical experience of respected authorities or both. Strength of recommendation A based on category I evidence, B based on category II evidence or extrapolated from category I evidence, C based on category III evidence or extrapolated from category I or II evidence, D based on category IV evidence or extrapolated from category I, II, or III evidence. IVIG: Intravenous immunoglobulin; AES: Acute encephalitis syndrome; ADEM: Acute disseminated encephalomyelitis; ALERD: Acute leukoencephalitis with restricted diffusion; ANEC: Acute necrotizing encephalopathy of childhood; FIRES: Febrile infection related epilepsy syndrome; MODS: Multiorgan dysfunction syndrome; SE: Status epilepticus.

Table 2 Hematological, cardiac and immunological indications, outcomes, and evidence for intravenous immunoglobulin use, n (%)

Condition (% of total)	Received IVIG	Survived	Recommendation	Evidence	Strength
Hematological (9.2)	42	25 (59.5)
AIHA	3	3 (100)	No	II	B
Secondary HLH	39	22 (56.4)	No	III	C
Cardiac (1.5)	7	6 (85.7)
Myocarditis	7	6 (85.7)	No	III	C
Immunological (42.4)	193	154 (79.8)
PID	11	5 (45.5)	Yes	Ia	A
Kawasaki disease	10	7 (71)	Yes	Ia	A
MIS-C	172	142 (82.6)	No	Ib	B

IVIG: Intravenous immunoglobulin; AIHA: Autoimmune hemolytic anemia; HLH: Hemophagocytic lymphohistiocytosis; PID: Primary immunodeficiency; MIS-C: Multisystem inflammatory syndrome in children.

Table 3 Dose of intravenous immunoglobulin used in diseases, frequency and survival, n (%)

Dose of IVIG (g/kg)	Indications	Received IVIG	Survived
0.5	PID	2	2 (100)
1	AES, FIRES, Dengue, adenovirus, mycoplasma, HLH, PID, KD, myocarditis	105	61 (58.1)
2	AES, ADEM, ALERD, ANEC, GBS, MG, autoimmune encephalitis, Dengue, HLH, AIHA, myocarditis, KD, MIS-C	339	282 (83.2)
4	Guillain-Barré syndrome	9	8 (89)

IVIG: Intravenous immunoglobulin; PID: Primary immunodeficiency; AES: Acute encephalitis syndrome; FIRES: Febrile infection related epilepsy syndrome; HLH: Hemophagocytic lymphohistiocytosis; KD: Kawasaki disease; ADEM: Acute disseminated encephalomyelitis; ALERD: Acute leukoencephalitis with restricted diffusion; ANEC: Acute necrotizing encephalopathy of childhood; GBS: Guillain Barre syndrome; MG: Myasthenia gravis; AIHA: Autoimmune hemolytic anemia; MIS-C: Multisystem inflammatory syndrome in children.