To assess in a retrospective analysis if there is evidence suggesting
corticosteroids can prevent the neurologic complications of
intravenous immunoglobulin (
IVIG)
therapy in children with
immune thrombocytopenic purpura (
ITP). From March 1985 to September 1997, 112 children received
IVIG (1 g/kg/day for one or two dosages) for the treatment of
ITP. During the years 1990 to 1997, 23 children nonrandomly received a short course of
prednisone (2 mg/kg/day during and for 3 days after the completion of
IVIG therapy) as a prophylaxis against the neurologic complications of
IVIG therapy. The authors analyzed the data of all 112 children and compared the incidence of neurologic complications in those who received
prednisone prophylaxis with those who did not. The severity of the complications was assessed as follows: grade 1,
headache only; grade 2,
headache plus
vomiting; grade 3,
headache,
vomiting, and
fever; grade 4,
headache,
vomiting,
fever, and meningeal signs (
aseptic meningitis). Of the 23 children who received
prednisone prophylaxis, 2 (8.7%) experienced
headache and
vomiting after the completion of
prednisone prophylaxis. Of the 89 children without
prednisone prophylaxis, 27 (30.3%) experienced
neurologic symptoms of varying severity, including one patient with
aseptic meningitis proven by examination of the spinal fluid. Twelve of these patients needed additional hospital care for the complications. Children receiving
prednisone had a 78% lower risk of neurologic complications (OR = 0.22; CI = 0.05-0.90; P = 0.036). This retrospective study shows a short course of
prednisone therapy, given during and until 3 days after the completion of
IVIG infusion, is likely to decrease the incidence and severity of neurologic complications of
IVIG in children with
ITP.