Use of subcutaneous immunoglobulin 16% in critical pediatric patients under 10 kg in a reference hospital in Colombia

Introduction: Subcutaneous immunoglobulin (SCIG) has gained popularity as a route for immunoglobulin G (IgG) replacement due to its lesser volume and fewer systemic adverse effects compared with intravenous (IV) administration. During the 2022 shortage of IVIG, we used SCIG in the intensive care unit (ICU). Methods: We reviewed the clinical and immunological characteristics of 33 patients who received 16% subcutaneous immunoglobulin replacement in the intensive care unit in HOMI, a pediatric reference hospital in Colombia, from May 1st 2022, until May 31st 2023.
Results: We included 36 patients. The median age of the patients was 3.8 months, with a male predominance of 53%. The median weight at the first infusion was 4 kilograms. The most critical comorbidities were pneumonia in 26 (72%), prematurity in 13 (36%), and congenital heart disease in 14 (39%). Viral or bacterial infection was present in almost all patients, with viral infection in 20 and bacterial infection in 28. Serum IgG was under the standard value for age in 42% of patients, IgM in 33%, and IgA in 69%; only 11% presented panhypogammaglobulinemia. In our cohort, 58% of patients were lymphopenic, and 61% were thrombocytopenic at the first infusion; the lowest platelet count registered was 40.800 x 103/uL. The first infusion was applied in the ICU in 34 patients, with SCIG in 77%. The main adverse event with the SCIG infusion was pain in 69% and there were no cases of allergy or anaphylactic reactions, cellulitis, bleeding or hematoma. The mortality in this cohort was 25%.
Conclusions: The 16% SCIG was a safe option for patients in the ICU, with lower total volume administration and fewer systemic reactions; none of our patients presented any severe adverse events, and the most frequent complication was pain during the application.

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