Immunomodulation, part II: granulocyte colony-stimulating factors

Although rhG-CSF and rhGM-CSF appear to have no adverse side effects, their usefulness in treating and preventing sepsis in preterm infants remains uncertain. Adequately powered, random, controlled clinical trials of neutropenic infants are needed to further evaluate efficacy of these agents as adjuncts to antibiotic therapy. Carr and associates assert that available data do not support further study of rhG-CSF and rhGM-CSF in septic infants who are not neutropenic. A United Kingdom study of the efficacy of prophylactic GM-CSF in reducing systemic infection or mortality in infants at high risk for postnatal neutropenia is underway. No plans exist for a long-term follow-up study, however. Because infection has the potential to cause both short-term mortality and long-term neurologic disability, it is recommended that all future studies include long-term neurologic and neurodevelopmental follow-up. The next part of this series will explore the use of intravenous immunoglobulins to prevent and treat neonatal sepsis.