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Increasing demands and consequent shortages result in a need for usage to conform to guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We retrospectively evaluated <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> use for neuroimmunological indications and adherence to existing guidelines in a major Australian paediatric hospital between 2000 and 2014.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One\u2010hundred and ninety\u2010six children (96 male, 100 female; mean age at disease onset 6y 5mo [range 3mo\u201315y 10mo], mean age at first <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> dose 7y 2mo [range 3mo\u201316y 5mo]) received <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> for neuroimmunological indications during the study period (28.1% had Guillain\u2013Barr\u00e9 syndrome), representing 15.5% of all hospital indications. In total, 1669 <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> courses were administered (total 57 221g, median 78g\/patient, range 12\u20135748g). The highest median numbers of courses were in chronic inflammatory demyelinating polyneuropathies, opsoclonus\u2010myoclonus ataxia syndrome, suspected immune\u2010mediated epilepsies, and Rasmussen's encephalitis. Adverse reactions occurred in 25.5% of patients, but these were mostly minor. Outcome at follow\u2010up was best in anti\u2010<jats:italic>N<\/jats:italic>\u2010methyl\u2010<jats:sc>d<\/jats:sc>\u2010aspartate receptor (anti\u2010<jats:styled-content style=\"fixed-case\">NMDAR<\/jats:styled-content>) encephalitis, Guillain\u2013Barr\u00e9 syndrome, and myasthenia gravis, and worst in Rasmussen's encephalitis and epilepsies. The total cost of <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> was <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>$2 595 907 (median $3538\/patient, range $544\u2013260 766). Of patients receiving <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content>, 45.4% to 57.1% were given the therapy for \u2018weak\u2019 indications or indications \u2018not listed\u2019 in international guidelines. Some entities commonly treated with <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> in current practice, such as anti\u2010<jats:styled-content style=\"fixed-case\">NMDAR<\/jats:styled-content> encephalitis and transverse myelitis, are not listed in most guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Our study demonstrates that <jats:styled-content style=\"fixed-case\">IVIG<\/jats:styled-content> is generally well tolerated but expensive, and discloses discrepancies between guidelines and clinical practice in paediatric neurology, suggesting both the need for greater adherence to current recommendations, and for recommendations to be updated to accommodate emerging indications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.13159","type":"journal-article","created":{"date-parts":[[2016,5,31]],"date-time":"2016-05-31T10:06:43Z","timestamp":1464689203000},"page":"1180-1192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Intravenous immunoglobulin in paediatric neurology: safety, adherence to guidelines, and long\u2010term outcome"],"prefix":"10.1111","volume":"58","author":[{"given":"Margherita","family":"Nosadini","sequence":"first","affiliation":[{"name":"Neuroimmunology Group Institute for Neuroscience and Muscle Research Kids Research Institute Children's Hospital at Westmead University of Sydney Sydney NSW Australia"},{"name":"Paediatric Neurology Unit Department of Paediatrics University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shekeeb S","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Neuroimmunology Group Institute for Neuroscience and Muscle Research Kids Research Institute Children's Hospital at Westmead University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnese","family":"Suppiej","sequence":"additional","affiliation":[{"name":"Paediatric Neurology Unit Department of Paediatrics University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Sartori","sequence":"additional","affiliation":[{"name":"Paediatric Neurology Unit Department of Paediatrics University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell C","family":"Dale","sequence":"additional","affiliation":[{"name":"Neuroimmunology Group Institute for Neuroscience and Muscle Research Kids Research Institute Children's Hospital at Westmead University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"IVIG in Neurology Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,5,31]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12444"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.253"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016\u2013015\u20138499\u20132"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2006.01.015"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2007.01.002"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2008.02246.x"},{"key":"e_1_2_8_8_1","unstructured":"WimperisJ LunnM JonesA et al. 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