6583 Auditing the practices of intravenous immunoglobulin administration in a tertiary paediatric hospital in the United Arab Emirates

Objectives There are growing concerns regarding the substantial rise in intravenous immunoglobulin (IVIg) utilization for multiple purposes, encompassing off-label uses.¹ Given the global shortage and the high cost of this treatment, we sought to evaluate the IVIg administration practices at a tertiary pediatric hospital in the United Arab Emirates (UAE). Methods A retrospective analysis was done at Al Jalila Children's Hospital (AJCH) including patients below 18 years of age who received IVIg for various diagnoses between January 2019 and December 2021. Data was gathered from the electronic medical record (EMR) system including demographics, indications, lab tests prior to administration, pre- medications, dosage, concentration, and adverse reactions (ADR). Data was collected on Microsoft Excel and analysed with IBM Statistical Package for the Social Sciences (SPSS) software version 27, comparing the current practice to the AJCH IVIg Administration Guidelines approved in 2018. Results A total of 301 encounters of IVIg administration were recorded. This included 237 from inpatient wards, 50 from the pediatric intensive care unit, and 14 from the neonatal intensive care unit. IVIg was predominantly administered to patients with Kawasaki Disease and Paediatric Multisystem Inflammatory Syndrome (PIMS) at 35% (N=106) collectively, followed by immunodeficiencies (17%, N=52) as represented in graph 1. According to the hospital guidelines, 46% (N=139) had the required lab tests ordered before IVIg administration. For the remaining 54% (N=162), 95% (N=154) lacked IgA level collection. Pre-medication was given in 82% of the cases (N=248) and stand-by epinephrine order was placed in 62%(N=188). ADR to IVIg were seen in 27% (N=83), mainly featuring symptoms like fever, headache, and vomiting. Serious ADRs such as aseptic meningitis and anaphylaxis were seen in 12% (N=10) and 3% (N=4) respectively. ADRs were more frequent with human IVIg 10% than with 5% (p=0.0093). There were inconsistencies in documenting infusion rates and justifications for extended durations. Conclusion Over the three-year audit period, we observed a consistent rise in the usage of IVIg, potentially influenced by the COVID pandemic and the ensuing PIMS cases. Adherence to our hospital's guidelines concerning pre-administration investigations and premedication varied across departments over time. Notably, despite the risk of anaphylaxis highlighted in the guideline, epinephrine was not always ordered. We recommend incorporating a comprehensive care-set into the hospital's EMR system, inclusive of essential orders and a documentation template. Given the worldwide shortage,² it is suggested updating the current guidelines to specify approved indications, aiming to restrict its utilization. A re-audit is also recommended. References Fakhari, Z, Farsaei S, Sabzghabaee, AM. Predicting factors for the pattern of intravenous immunoglobulin utilization in a Middle Eastern university hospital. Journal of research in pharmacy practice 2018; 7(4), 188–194. https://doi.org/10.4103/jrpp.JRPP_18_73 Lee JJ, Saffian SM, Makmor-Bakry M, Islahudin F, Alias H, Ali A, Shah NM. Prescribing practices of intravenous immunoglobulin in tertiary care hospitals in malaysia: a need for a national guideline for immunoglobulin use. Frontiers in Pharmacology, 13.2022. https://doi.org/10.3389/fphar.2022.879287