Agrawal A. Intravenous immunoglobulin in pediatric critical care: Bridging evidence gaps and guiding rational use. World J Clin Pediatr 2026; 15(4): 121145 [DOI: 10.5409/wjcp.121145]
Corresponding Author of This Article
Amit Agrawal, Associate Professor, Department of Pediatrics, Gandhi Medical College, Hamidia Hospital Campus, 49-B Indrapuri, B-Sector, Bhopal 462001, Madhya Pradesh, India. agrawaldramit@yahoo.co.in
Research Domain of This Article
Immunology
Article-Type of This Article
editorial
Open-Access Policy of This Article
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World J Clin Pediatr. Dec 9, 2026; 15(4): 121145 Published online Dec 9, 2026. doi: 10.5409/wjcp.121145
Intravenous immunoglobulin in pediatric critical care: Bridging evidence gaps and guiding rational use
Amit Agrawal
Amit Agrawal, Department of Pediatrics, Gandhi Medical College, Hamidia Hospital Campus, Bhopal 462001, Madhya Pradesh, India
Author contributions: Agrawal A was responsible for concept, literature review, drafting and manuscript editing, revising the article critically for important intellectual content.
Conflict-of-interest statement: The author declares no conflict of interest in publishing the manuscript.
Corresponding author: Amit Agrawal, Associate Professor, Department of Pediatrics, Gandhi Medical College, Hamidia Hospital Campus, 49-B Indrapuri, B-Sector, Bhopal 462001, Madhya Pradesh, India. agrawaldramit@yahoo.co.in
Received: March 17, 2026 Revised: April 23, 2026 Accepted: May 27, 2026 Published online: December 9, 2026 Processing time: 186 Days and 1.9 Hours
Abstract
Intravenous immunoglobulin (IVIG) plays an important role in pediatric intensive care units (PICUs) in managing children with immune-mediated and inflammatory disorders. IVIG has been used to treat many diseases, such as Kawasaki disease, Guillain-Barré syndrome, immune thrombocytopenia, multisystem inflammatory syndrome in children, and autoimmune disorders. However, its off-label use in several ailments, including septic shock, acute encephalitis syndrome, and other hyperinflammatory states, is not uncommon. This editorial discusses a study by Varadarajan et al, published in World Journal of Clinical Pediatrics, which evaluated the pattern of IVIG use in a tertiary care hospital and found that about 21.5% patients received it off-label. The reported adverse effects were only a few. Despite plausible immunomodulatory mechanisms, various clinical trials have reported inconsistent findings regarding mortality benefits in children with sepsis. In addition, insufficient data on the dose, duration, safety, and cost-effectiveness of IVIG need to be considered before its widespread use in the PICU. Although the adverse effects of IVIG are generally mild and infrequent, judicious stewardship of IVIG use is necessary, given its high cost and reliance on human plasma. This editorial discusses the patterns of IVIG use in different diseases in PICUs, dosages, outcomes, consensus-driven guidelines, and the need for pediatric trials.
Core Tip: Intravenous immunoglobulin is increasingly being utilized in pediatric intensive care units for its diverse immunomodulatory effects, even beyond established indications. The study by Varadarajan et al highlights substantial off-label use with only a few adverse effects. This editorial provides a practical, evidence-based framework for the use of intravenous immunoglobulin in critically ill children, including indications, strength of evidence, and stewardship principles to guide its rational use.
