European Journal of Pediatrics

, Volume 155, Supplement 2, pp S21–S24 | Cite as

New modalities for treating neonatal infection

  • A. R. Bedford-Russell


While the overall incidence of infection has remained constant at approximately 7/1000 livebirths, the last decade has witnessed a reduction in early onset infections and a relative increase in nosocomial sepsis, chiefly with coagulase-negative staphylococci. Immaturity of host defence mechanisms contributes to an increasing susceptibility to infection with decreasing gestational age and birth weight. In the past, efforts to enhance host defence have included the use of granulocyte infusions, fresh frozen plasma, exchange blood transfusions and immunoglobulin therapy. Current trials are investigating the use of agents which enhance endogenous defence mechanisms, such as, recombinant human granulocyte colony-stimulating factant and recominant human granulocyte-macrophage colony-stimulating factor and of pentoxifylline. In the meantime strict attention to handwashing and aseptic technique remain the best methods of preventing nosocomial sepsis.

Key words

Neonatal infection Immunoglobulins rhG-CSF rhGM-CSF Pentoxifylline 



very low birth weight


intravenous immunoglobulin


recombinant human granulocyte colony-stimulating factor


recombinant human granulocyte-macrophage colony-stimulating factor


tumour necrosis factor-alpha


  1. 1.
    Alpan O, La Gamma EF, Parker RI (1995) Can treatment with recombinant granulocyte colony-stimulating factor transform neutropenia into leukaemia? J Pediatr 127:845PubMedGoogle Scholar
  2. 2.
    Baley JE, Stork EK, Warkentin PI, Shurin SB (1987) Buffy coat transfusions in neutropenic neonates with presumed sepsis: a prospective, randomised trial. Pediatrics 80:712–720PubMedGoogle Scholar
  3. 3.
    Bedford-Russell AR, Davies EG, McGuigan S, Scopes J, Gordon-Smith EC (1994) Plasma granulocyte colony-stimulating factor concentrations ([G-CSF]) in the early neonatal period. Br J Haematol 86:642–644PubMedGoogle Scholar
  4. 4.
    Bedford-Russell AR, Davies EG, Ball SE, Gordon-Smith E (1995) Granulocyte colony stimulating factor treatment for neonatal neutropenia. Arch Dis Child 72:F53-F54Google Scholar
  5. 5.
    Bedford-Russell AR, Davies EG, Gibson FM, Gordon-Smith EC (1995) The in-vitro effects of granulocyte and granulocyte-macrophage colony-stimulating factor on interleukin-3-dependent proliferation of human neonatal circulating progenitor cells. Pediatr Res 37:630–633PubMedGoogle Scholar
  6. 6.
    Cairo MS (1991) Cytokines: a new immunotherapy. Clin Perinatol 18:343–359PubMedGoogle Scholar
  7. 7.
    Cairo MS (1993) Therapeutic implications of dysregulated colony-stimulating factor expression in neonates. Blood 82:2269–2272PubMedGoogle Scholar
  8. 8.
    Cairo MS, Rucker R, Bennets GA (1984) Improved survival of newborns receiving leukocyte transfusions for sepsis. Pediatrics 74:887–892PubMedGoogle Scholar
  9. 9.
    Cairo MS, Christensen R, Sender LS, Ellis R, Rosenthal J, Ven C van de, Worcester C, Agosti JM (1995) Results of a phase I/II trial of recombinant human granulocyte-macrophage colony-stimulating factor in very low birth-weight neonates: significant induction of circulatory neutrophils, monocytes, platelets and bone marrow neutrophils. Blood 86:2509–2515PubMedGoogle Scholar
  10. 10.
    Christensen RD, Rothstein G (1980) Exhaustion of mature marrow neutrophils in neonates with sepsis. J Pediatr 96:316–318PubMedGoogle Scholar
  11. 11.
    Christensen RD, Rothstein G, Anstall HB, Bybee B (1982) Granulocyte transfusions in newborns with bacterial infection, neutropenia and depletion of mature marrow neutrophils. Pediatrics 70:1–6PubMedGoogle Scholar
  12. 12.
    Clapp DW, Baley JE, Liegman RM, et al (1989) Use of intravenously administered immunoglobulin to prevent nosocomial sepsis in low birthweight infants:report of a pilot study. J Pediatr 115:973–978PubMedGoogle Scholar
  13. 13.
    Cooke RWI (1991) Factors associated with chronic lung disease in preterm infants. Arch Dis Child 66:776–779PubMedGoogle Scholar
  14. 14.
    Dalvi R, Rao S, Rangnekar J, Fernandez A (1991) Exchange transfusions in neonatal sepsis. Indian Pediatr 28:39–43PubMedGoogle Scholar
  15. 15.
    Doebbeling BN, Stanley GL, Sheetz CT, Pfaller MA, Houston AK, Annis L, Wenzel P (1992) Comparative efficacy of alternative handwashing agents in reducing nosocomial infections in intensive care units. N Engl J Med 327: 88–93PubMedGoogle Scholar
  16. 16.
    Doron MW, Makhlouf RA, Katz VL, Lawson EE, Shtec PD (1994) Increased incidence of sepsis at birth in neutropenic infants of mothers with pre-eclampsia. J Pediatr 125:452–458PubMedGoogle Scholar
  17. 17.
    Freeman J, Goldman DA, Smith NE (1990) Association of intravenous lipid emulsion and coagulase-negative Staphylococcal bacteraemia in neonatal intensive care units. N Engl J Med 323:301–308PubMedGoogle Scholar
  18. 18.
    Gillan ER, Christensen RD, Suen Y, Ellis R, Ven C van de, Cairo MS (1994) A randomised placebo-controlled trial of recombinant human granulocyte colony-stimulating factor administration in newborn infants with presumed sepsis: significant induction of peripheral and bone marrow neutrophilia. Blood 84:1427–1433PubMedGoogle Scholar
  19. 19.
    Gorgen I, Hartung T, Leist M, Niehorster M, Tiegs G, Uhlig S, Weitzel F, Wendel A (1992) Granulocyte colony-stimulating factor treatment protects rodents against lipopolysaccharide-induced toxicity via suppression of systemic tumor necrosis factor-α. J Immunol 149: 918–923PubMedGoogle Scholar
  20. 20.
    Lacy JB, Ohlsson A (1995) Administration of intravenous immunoglobulins for prophylaxis or treatment of infection in preterm infants: meta-analyses. Arch Dis Child 72:F151-F155Google Scholar
  21. 21.
    Laurenti F, Ferro R, Isacchi G (1981) Polymorphonuclear leukocyte transfusion for the treatment of sepsis in the newborn infant. J Pediatr 98:118–123PubMedGoogle Scholar
  22. 22.
    Lauterbach R, Pawlik D, Tomaszczyk B, Cholewa B (1994) Pentoxifylline treatment of sepsis of premature infants: preliminary clinical observations Eur J Pediatr 153:672–674CrossRefPubMedGoogle Scholar
  23. 23.
    Philip AGS (1994) The changing face of neonatal infection: experience at a regional medical centre. Pediatr Infect Dis J 13:1098–1102PubMedGoogle Scholar
  24. 24.
    Murch SH, MacDonals TT, Wood CBS, Costeloe KL (1992) Tumour necrosis factor in the bronchoalveolar secretions of infants with the respiratory distress syndrome and the effect of dexamethasone treatment. Thorax 47:44–47PubMedGoogle Scholar
  25. 25.
    Stehle B, Weiss C, Ho AD, Hunstein W (1990) Serum levels of tumor necrosis factor α in patients treated with granulocyte-macrophage colony-stimulating factor. Blood 75:1895–1899PubMedGoogle Scholar
  26. 26.
    Thompson PJ, Greenough A, Hird MF, Philpott-Howard J, Gamsu HR (1992) Nosocomial bacterial infections in very low birth weight infants. Eur J Pediatr 151:451–454CrossRefPubMedGoogle Scholar
  27. 27.
    Toda H, Murata A, Oka Y, Uda K, Tanaka N, Ohashi I, Mori T, Matsuura N (1994) Effect of granulocyte colony-stimulating factor on sepsis-induced organ injury in rats. Blood 83:2893–2898PubMedGoogle Scholar
  28. 28.
    Van de Poll T, Buller HR, Cate H ten, Wortel CH, Bauer KA, Deventer SJH van, Hack CE, Sauerwein HP, Rosenberg RD, Cate JW ten (1990) Activation of coagulation after administration of tumor necrosis factor to normal subjects. N Engl J Med 322:1622–1627PubMedGoogle Scholar
  29. 29.
    Weinblatt ME (1995) Can treatment with recombinant granulocyte colony-stimulating factor transform neutropenia into leukaemia? J Pediatr 127:845–846PubMedGoogle Scholar
  30. 30.
    Weisman LE, Cruess DF, Fischer GW (1994) Opsonic activity of commercially available standard intravenous immunoglbulin preparations. Pediatr Infect Dis J 13:1122–1125PubMedGoogle Scholar
  31. 31.
    Williams AF (1994) Is breastfeeding beneficial in the UK? Arch Dis Child 71:376–380PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • A. R. Bedford-Russell
    • 1
  1. 1.Neonatal Intensive Care UnitSt George's HospitalLondonUK

Personalised recommendations