A multicenter, randomized, placebo-controlled trial of prophylactic recombinant granulocyte-colony stimulating factor in preterm neonates with neutropenia.
OBJECTIVE
To test the hypothesis that prophylactic treatment of neutropenic premature neonates with recombinant granulocyte-colony stimulating factor (rG-CSF) would reduce the incidence of nosocomial infections (NIs).


METHODS
A total of 25 neonatal intensive care units participated in this multicenter, randomized, double-blind, placebo-controlled trial. Premature infants of gestational age (GA) <or= 32 weeks were included if they had a peripheral blood count showing < 1500 neutrophils/mm(3) for at least 24 hours during the first 3 weeks of life. A total of 200 infants received either rG-CSF (10 microg/kg/day) or placebo for 3 days. Primary outcome was survival free of infection for 4 weeks after treatment, assessed in an intention-to-treat analysis.


RESULTS
A total of 102 infants received rG-CSF (mean GA, 29.2 weeks), and 98 received placebo (mean GA, 29.1 weeks). Survival free of confirmed infection for 4 weeks after treatment was 74/102 in the rG-CSF group and 66/98 in the placebo group (P = .42). However, during 2 weeks, there was a significant difference between groups (86/102 vs 70/98; P = .028).


CONCLUSIONS
In this population, prophylactic rG-CSF did not significantly increase survival free of infection at 4 weeks after treatment. The transient effect observed at 2 weeks in the most immature infants should be evaluated further.
Kuhn
Pierre
P
Réanimation néonatale, Service de Pédiatrie 2, Hôpital de Hautepierre, CHRU Strasbourg, France. pierre.kuhn@chru-strasbourg.fr
Messer
Jean
J
Paupe
Alain
A
Espagne
Sandrine
S
Kacet
Nadine
N
Mouchnino
Genevieve
G
Klosowski
Serge
S
Krim
Gérard
G
Lescure
Sandra
S
Le Bouedec
Stephane
S
Meyer
Pierre
P
Astruc
Dominique
D
D003428:Cross Infection / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D005865:Gestational Age; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy*; D019102:Infant, Very Low Birth Weight; D007958:Leukocyte Count; D008297:Male; D009503:Neutropenia / Q000175:diagnosis / Q000188:drug therapy*; D011994:Recombinant Proteins; D016896:Treatment Outcome
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor