Immunotherapy of neonatal septicemia

Area of Science:

• Neonatal immunology
• Infectious diseases in neonates

Background:

• Neonate immune defense is immature, increasing susceptibility to invasive bacterial diseases, particularly in premature infants.
• Existing immunotherapeutic strategies, including exchange transfusion, granulocyte transfusion, intravenous immunoglobulin, and fibronectin, are reviewed for their potential in treating infected infants.

Purpose of the Study:

• To review the current literature on immunodeficiencies in neonates and the efficacy of various immunotherapeutic interventions for invasive bacterial infections.
• To provide recommendations for the management of septic newborns with neutropenia.

Main Methods:

• Literature review of immune deficiencies in neonates and immunotherapeutic agents.
• Analysis of clinical trial data, where available, for interventions like granulocyte transfusion.

Main Results:

• No randomized controlled trials exist for exchange transfusion, immunoglobulin, or fibronectin in infected infants.
• Clinical trials for granulocyte transfusion in infected newborns show conflicting results, indicating a need for further evaluation.

Conclusions:

• Immunotherapeutic interventions require further rigorous evaluation.
• Recommend granulocyte transfusion (1 x 10^9 irradiated cells/kg) for septic newborns with neutropenia (I/T ratio >= 0.8) unresponsive to conventional therapy.
• If granulocyte isolation is unavailable, a double-volume exchange transfusion with fresh heparinized whole blood can provide functional phagocytes.