Current status of granulocyte transfusions to treat neonatal sepsis

Neonates are unusually susceptible to severe bacterial infections. Antibiotic therapy has been supplemented with granulocyte transfusions (GTX) to treat neonatal infections. The precise role of GTX to treat neonatal sepsis is controversial, and 11 reports (including six controlled studies) were critically analyzed. When all data are combined, 79% of 78 neonates receiving antibiotics plus GTX survived vs. 62% of 90 infants treated only with antibiotics. Among the six controlled trials, four found significantly better survival for neonates given GTX plus antibiotics. However, each of these trials can be criticized (few subjects, heterogeneous patients, defective design, inadequate granulocyte product, etc.). Although firm recommendations for GTX cannot be made currently, it seems reasonable to combine them with antibiotics to treat septic neonates that exhibit neutropenia for age and evidence of a diminished neutrophil marrow storage pool. Once the decision to transfuse is made, neonates should receive a minimum dose of 1 x 10(9) fresh neutrophils per kg per transfusion.