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nosocomial infections (52).

**7. Conclusions** 

**Author details** 

**8. References** 

Elisabeth Resch and Bernhard Resch

*Department of Pediatrics, Medical University of Graz, Austria* 

organization. Pediatrics 1999;103:360–733.

significant reduction in sepsis (number needed to treat – NNT - 36) and/or any serious infection (NNT 31), but no reduction in mortality from infection. The reviewers concluded that IVIG administration resulted in a 3% reduction in sepsis and a 4% reduction in any serious infection of one or more episodes. Nevertheless it was not associated with reductions in other important outcomes including necrotizing enterocolitis intraventricular haemorrhage, or length of hospital stay. Most importantly, IVIG administration did not have any significant effect on mortality from any cause or from infections. There were no adverse events observed to be associated with prophylactic use of IVIG. From a clinical perspective a 3-4% reduction in nosocomial infections without a reduction in mortality or other important clinical outcomes might be of marginal importance and has to be outweighed by the costs and the values assigned to the clinical outcomes (52). This Cochrane review ends with the statement that there is no justification for further randomized trials testing the efficacy of previously studied IVIG preparations to reduce nosocomial infections in preterm and/or low birth weight infants. In contrast, these results should encourage basic scientists and clinicians to pursue other avenues to prevent

There is a rational to use of IVIG in either adjunctive treatment neonatal sepsis or in the prevention by low immunoglobulin levels associated with the immature innate immune system of preterm infants. Studies so far revealed a benefit for IgM enriched IVIG in the use as adjunctive sepsis treatment by an overall significantly reduced mortality rate. Prophylactic use of IVIG resulted in marginally reduced rates of nosocomial infections, and other non-invasive approaches like use of lactoferrin (53) and/or probiotics (54) seem to be more promising in the prevention of nosocomial infections in very low birth weight infants.

*Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology,* 

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