Influence of maternal preeclampsia on recombinant human granulocyte colony-stimulating factor effect in neutropenic neonates with suspected sepsis.
OBJECTIVE
To evaluate the effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in preterm neonates with suspected sepsis and severe neutropenia (<1500 mm(3)), and to define the influence of maternal preeclampsia on rhG-CSF activity.


METHODS
Twenty neonates of normotensive mothers (NNMs) (GA 29.2+/-0.5 weeks and BW 1.024+/-81 g) and 20 born to preeclamptic mothers (NPMs) (GA 29+/-0.4 weeks and BW 946+/-55 g) were treated with rhG-CSF, 10 microg/kg per day for 3 days. Complete blood counts were obtained at day 0 (before rhG-CSF administration) and 1-4, 6, 9, 20 and 30 days later.


RESULTS
Absolute neutrophil count (ANC) increased rapidly (three-fold within 24h), and significantly (maximum approximately 20-25 times starting values) and remained within normal range in both groups. However, in NNMs a two-phase increase occurred with an early peak on day 2 and a further peak on day 6 giving significantly higher ANC (P<0.001) than for NPMs at days 2-4 and 6. NPMs showed a gradual ANC increase with a single late peak occurring 3 days later than NNMs (day 9). The highest peak values for ANC were similar (15,900+/-1395 mm(-3) for NNMs and 13,880+/-1097 mm(-3) for NPMs). Neutropenia was completely resolved within 2 days in NNMs and within 4 days in NPMs.


CONCLUSIONS
Preeclampsia seemed to influence the course of the ANC in spite of rhG-CSF administration, and a higher daily-dose for NPMs with neutropenic sepsis may more rapidly resolve neutropenia by overcoming the preeclampsia-associated inhibitor of rhG-CSF through a dose-dependent mechanism.
Zuppa
Antonio Alberto
AA
Division of Neonatology, Department of Pediatrics, Catholic University of Sacred Heart, Rome, Italy. zuppaaa@rm.unicatt.it
Girlando
Pietro
P
Florio
Maria Grazia
MG
Cota
Francesco
F
Romagnoli
Costantino
C
Tortorolo
Giuseppe
G
D016470:Bacteremia / Q000097:blood / Q000382:microbiology; D004927:Escherichia coli Infections / Q000097:blood; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007700:Kinetics; D007710:Klebsiella Infections / Q000097:blood; D007711:Klebsiella pneumoniae; D007958:Leukocyte Count; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D011225:Pre-Eclampsia / Q000150:complications*; D011247:Pregnancy; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D018805:Sepsis / Q000097:blood*; D013203:Staphylococcal Infections / Q000097:blood; D013290:Streptococcal Infections / Q000097:blood
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor