IVIG Cuts Mortality in Infants with Acute Myocarditis

In contrast to six deaths in 13 infants (46 percent) treated with conventional supportive care for severe acute myocarditis, just one of 12 infants (8 percent) who additionally received high-dose (2 gram/kg) IVIG died during their hospitalization, according to a review of all cases between 2004 and 2007 admitted to the Aga Khan University Hospital in Karachi, Pakistan. This striking mortality difference was statistically significant (p = 0.04). Pakistani hospitals generally do not have access to mechanical circulatory support technology (which contributes to higher mortality in cases of severe myocarditis) commonly used in the U.S.

All patients had antecedent gastrointestinal or respiratory illness, hepatomegaly, pulmonary edema and metabolic acidosis. Baseline ejection fraction in the two groups was not significantly different (17.5 percent and 22.5 percent). Children with preexisting structural heart defects, cardiomyopathy, coronary anomalies, sepsis or Kawasaki disease were excluded.

While acknowledging limitations that included a small sample size and a retrospective study design, the authors concluded that their findings “provide support for aggressive supportive care and early use of IVIG in acute myocarditis in children.”