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|Year : 1979 | Volume
| Issue : 2 | Page : 97-101
Immunoglobulins in newborns: Differential study of premature and full term infants
KR Ravivarma1, ST Babar1, J Master1, JP Bapat2, AJ Baxi2
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
K R Ravivarma
Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Bombay-400 012
Source of Support: None, Conflict of Interest: None
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|| |
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. ,, 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  have demonstrated that there is high incidence of antigammaglobulin antibodies in the children with hypogammaglobulinemia, despite their increased susceptibility to infection. Further these authors  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|| |
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  as described by Baxi et at  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|| |
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. ,, 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  though the difference was not statistically significant in the present study. IgA was not detectable in the `small for date' and preterm groups. Raghavan  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|| |
Immunoglobulin studies in the newborn have attracted a great deal of attention in recent years. ,, 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. , 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  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. ,, 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|| |
We thank Dr. S. M. Merchant and Dr. H. M. Bhatia for their interest in the investigation.
| :: References|| |
|1.||Ackerman, B. D.: Congenital syphilis-Observations on laboratory diagnosis of intra-uterine infections. J. Paediat., 74: 459-461, 1969. |
|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. |
|3.||Baxi, A. J., Bapat, J. P. and Kulkarni, K. V.: Immunoglobulin levels in Hepatitis B Antigenemia. Bull. Haffkine Inst., 3: 156-158, 1975. |
|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. |
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|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. |
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|13.||Samuel, A. M.; Deshpande, U. R, and Singh, B.: Immunoglobulins in normal adult Indians. Ind. J. Med. Res., 58: 56-64, 1970. |
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[Table 1], [Table 2], [Table 3]