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 ::  Abstract
 ::  Introduction
 ::  Material And Methods
 ::  Results
 ::  Discussion
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ARTICLE
Year : 1979  |  Volume : 25  |  Issue : 2  |  Page : 97-101

Immunoglobulins in newborns: Differential study of premature and full term infants


1 Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Bombay-400 012, India
2 Blood Group Reference Centre Unit, Haffkine Institute, Acharya Donde Marg, Parel, Bombay-400 012, India

Correspondence Address:
K R Ravivarma
Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Bombay-400 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 501676

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 :: Abstract 

Present study deals with the immunoglobulin levels of the preterm and normal infants born of normal and infected mothers.
Mean IgG in the full term infants (born of normal mothers) Was found to be 75% of the adult level. However mean IgG level was slightly higher in "small for date" babies than the preterm, but lower than the full term. IgM levels were comparable in all the three categories, whereas detectable IgA was found only in full term infants.
A variable pattern was observed in the infants of all the three groups, born of infected mothers.
There appeared to be a correlation of increased IgG with higher birth weight while lower birth weight infants had increased IgM.



How to cite this article:
Ravivarma K R, Babar S T, Master J, Bapat J P, Baxi A J. Immunoglobulins in newborns: Differential study of premature and full term infants. J Postgrad Med 1979;25:97-101

How to cite this URL:
Ravivarma K R, Babar S T, Master J, Bapat J P, Baxi A J. Immunoglobulins in newborns: Differential study of premature and full term infants. J Postgrad Med [serial online] 1979 [cited 2020 Oct 28];25:97-101. Available from: https://www.jpgmonline.com/text.asp?1979/25/2/97/42117



 :: Introduction Top


It is well recognised that the primary immunoglobulin (Ig) of the newborn is the maternal IgG as this is the only Ig to cross the placental barrier. On the other hand, it is IgM which is synthesized by the newborn in the early postnatal period followed by IgA and IgG. [10],[11],[16] Thus the humoral immunity of the newborn is largely determined by the immune status of the mother.

A great deal of attention has been given to the study of infections in preg­nant women with a view to determine the effect on the fetus in utero as well as in the newborn. Stiehm, et al [15] have de­monstrated that there is high incidence of antigammaglobulin antibodies in the children with hypogammaglobulinemia, despite their increased susceptibility to infection. Further these authors [15] point to the fact that incompatible fetal mater­nal Gm (genetic determinants on IgG molecule) immune response may result in the development of anti gamma globu­lin antibody in the mother which may interact with the fetus. The question naturally arises as to what reaction sequelae would occur in the fetus as well as in the newborns, if the mothers were treated with pooled γ-globulin to combat bacterial and/or viral infection?

Present study therefore was designed to determine the Ig levels of preterm and normal infants born of normal and infected mothers with a view to ascertain the base line immune response. These observations may help better understand­ing of events in the antenatal period, and at birth. Results of preliminary observa­tions are recorded in this communication.


 :: Material And Methods Top


Infants of both the sexes in the control group and those born of infected mothers were studied in the present investigations. Both the groups contained infants born full term, preterm and "small for date". Details are given in [Table 1] and [Table 2].

Clear unhemolysed serum was used for the immunoglobulin determinations. IgG, IgM and IgA were estimated by the radial immunodiffusion technique of Mancini et al [9] as described by Baxi et at [3] using controls and antisera suppli­ed by Hoechst Behringwerke AG, Mar­burg-Lahn, Germany. Standard curve was plotted for each new batch of 'anti­sera'. The precipitin diameter was measured to the fraction of a millimeter by a scale supplied by the manufacturer, and the results were computed as mg/dl.


 :: Results Top


Ig levels in the normal group are shown in [Table 1]. Mean IgG in full term infants was found to be about 75% of the adult level. [3],[14],[15] However mean IgG level was slightly higher in `small for date' babies than the preterm but lower than the full term. The latter observations are supported by those of Raghavan et al [12] though the difference was not statistically significant in the present study. IgA was not detectable in the `small for date' and preterm groups. Raghavan [12] and her colleagues were able to detect IgA in five out of 15 preterni infants. IgM was comparable in all the three categories examined.

Ig pattern [Table 2] in the infants born of mothers who had infections ante­natally was variable when compared with the normal group. IgG was lower in full term infants in the infected group than in corresponding normal group. On the other hand IgG level was about 25% higher in preterm infants than those in the control group. IgG levels were com­parable for small for weight infants in normal and infected group. IgM levels were markedly increased in all the three categories in the infected group. These observations are in accord with those of Alford et ale and Ackerman.' No diffe­rences were noted in IgA, levels of infants in this group.

There appeared to be a correlation of increased IgG with higher birth weight (> 2500 gm) while increased IgM was correlated with the lower birth weight infants [Table 3].


 :: Discussion Top


Immunoglobulin studies in the new­born have attracted a great deal of atten­tion in recent years. [5],[11],[16] It is univer­sally accepted that IgG is the only immu­noglobulin that selectively crosses placenta. Thus there is a remarkable parallelism between the IgG of newborns and their mothers. However, in recent years, it is shown that there is some `denovo' synthesis of IgG in the new­borns. [4],[16] Exact reasons for this pheno­menon are obscure at present. There is equally a strong evidence that IgM im­munoglobulin is increased in neonates born of mothers who had infections dur­ing pregnancy. Paul and Wee [11] have de­monstrated higher IgM level in infants whose mothers had variety of intra-ute­rine infections such as rubella, syphilis, toxoplasmosis and others. The increase in IgM is maximum in full term infants than in small for date' infants with an intermediate level in preterm infants. These observations are of great interest. It would seem that immune tolerance in the latter groups as compared to full term may be responsible for such a pic­ture. In addition, it is likely that immune response may be suppressed to some ex­tent in the preterm and `small for date' infants because of prematurity and lower metabolic status. Further studies are needed to elucidate the point.

The study of Ig levels in preterm and `small for date' babies is important clini­cally since the morbidity and mortality in this group is quite high. Ig admini­stration to three mothers in the infected group did not result in any untoward re­actions (unpublished). The newborns of these treated mothers had normal IgG level and there was no evidence of antiγ-globulin (anti-Gm) antibodies in the serum. These findings differ from those of Fudenberg's group. [6],[15],[16] The latter authors report of clinical anaphylactic re­actions on intravenous administration of pooled human Ig. The absence of such reactions in our study may be due to the intramuscular administration of Ig and may thus be related to mode of admini­stration of Ig.

Results obtained in the present study indicate a clear picture of Ig status in the preterm and full term infants and the interplay of infection on possible influ­ence on the immune status of the new­born. Larger study is indicated for un­equivocal conclusions such as mentioned above.


 :: Acknowledgements Top


We thank Dr. S. M. Merchant and Dr. H. M. Bhatia for their interest in the investigation.

 
 :: References Top

1.Ackerman, B. D.: Congenital syphilis-­Observations on laboratory diagnosis of intra-uterine infections. J. Paediat., 74: 459-461, 1969.  Back to cited text no. 1    
2.Alford, C. A., Schaefer. J., Blankenship, W. J , , Straumfjord, J. V. and Cassady, CG.: A correlative, immunologic, micro­biologic and clinical approach to the diag­nosis of acute and chronic infections in newborn infants. New Engl. J. Med. 277: 437-449, 1967.  Back to cited text no. 2    
3.Baxi, A. J., Bapat, J. P. and Kulkarni, K. V.: Immunoglobulin levels in Hepatitis B Antigenemia. Bull. Haffkine Inst., 3: 156-158, 1975.  Back to cited text no. 3    
4.Bharucha, P. E., Baxi, A. J., Wagh, S. and Bharucha, E. P.: Tetanus immune­globulin after antenatal immunization. Current Topics in Paediatrics XV Intern. Cong. Paediatrics, New Delhi, 1977, p. 114.  Back to cited text no. 4    
5.Chandra, R. K., Guha, D. K, and Ghai, O. P. Serum immunoglobulins in new borns Ind. J. Paediat., 37: 361-364, 1970.  Back to cited text no. 5    
6.Fudenberg, H. H. and Fudenberg, B. R.: Antibody to hereditary human gamma globulin (Gm), factor resulting from maternal-fetal incompatibility. Science, 145: 170-171, 1964.  Back to cited text no. 6    
7.Lala, S. P., Sinha, K. P., Sen, D. K. and Mallick, H.: A study of immunoglo­bulins in Indian Children. Ind. J. Med. Res. 59: 107-114, 1971.  Back to cited text no. 7    
8.Malik, G. B., Reys, M. and Raghavan, U.: Serum proteins including immuno­globulins in neonates born under abnor­mal situations. Ind. Paediatrics, 14: 699­703, 1977.  Back to cited text no. 8    
9.Mancini, G., Carbonara, A. O. and Heremans, J. F.: Immunochemical quantitation of antigens by single-radial immunodiffusion. Immunochemistry, 2: 235-239, 1965.  Back to cited text no. 9    
10.Notation for Genetic factors of human immunoglobulins. Bull. W.H.O. 33: 721­724, 1965.  Back to cited text no. 10    
11.11, Paul, F. M. and Wee, R.: A study of im­munoglobulin levels in Singapore infants and children. J. Singapore Paediat. Soc., 12: 22-38, 1970.  Back to cited text no. 11    
12.Raghavan, U., Malik, G. B . , Rays, M . and Malaviya, A. N.: Serum proteins with special reference to immunoglobulins, in premature Indian neonates. Ind. Pediatrics, 13: 815-81.9, 1976.  Back to cited text no. 12    
13.Samuel, A. M.; Deshpande, U. R, and Singh, B.: Immunoglobulins in normal adult Indians. Ind. J. Med. Res., 58: 56-64, 1970.  Back to cited text no. 13    
14.Samuel, A. M., Patel, B. D. and Man­kodi, N. A.: A study of immunoglobulins in protein calorie malnutrition. Ind. J. Med. Res. 60: 1278-1283, 1972.  Back to cited text no. 14    
15.Stiehm, F. R. and Fudenberg, H. H.: Antibodies to gamma-globulin in infants and children to isologous gamma-globulin. Pediatrics, 35: 229-235, 1965.  Back to cited text no. 15    
16.Stiehm, E. R. and Fudenberg, H. H.: Serum levels of immunoglobulins in health and disease-A survey. Pediatrics,. 37: 715-727. 1966.  Back to cited text no. 16    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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