STABILITY AND ACTIVITY OF INTRAVENOUS IMMUNOGLOBULIN WITH NEONATAL, DEXTROSE AND TOTAL PARENTERAL NUTRIENT SOLUTIONS

OBJECTIVE: TO determine in vitro the compatibility of reconstituted intravenous immunoglobulin (IVIG) (Gammagard, Baxter-Hyland) with five different neonatal and pediatric intravenous solutions in Viaflex polyvinyl chloride bags. DESIGN: In vitro compatibility study. INTERVENTIONS: Samples were taken at time=0, 10, 30, 60, 90, and 120 minutes and at 4, 8, 12, and 24 hours and assayed for total immunoglobulin G content and antibodies to hepatitis B surface antigen. Type m group B Streptococcus (GBS) and opsonic activity for type m GBS were analyzed at time=0, 60, and 120 minutes and 12 and 24 hours. All results were compared with those from pure MG. RESULTS: Our results demonstrate that mixing IVIG with intravenous solutions commonly used in the care of premature infants (dextrose 5% in water [D5W], D15W, DSW/NaCl 0.225%, and total parenteral nutrition [TPN]) does not significantly alter total immunoglobulin G concentrations or concentration of antibodies to hepatitis B Surface antigen or type m GBS. As well, the in vitro functional activity for type m GBS of the MG, when mixed with these solutions for up to 24 hours, remained intact. An apparent decrease in bactericidal killing was seen with the IVIG/central TPN mixture. This apparent decrease was found to be an artifact of the high concentration of glucose (20 percent) in the solution. CONCLUSIONS: We propose that Gammagard may be mixed with these solutions through Y-site connections without loss of antibody content or functional activity of the IVIG.