Pathophysiology and treatment of septic shock in neonates.
Neonatal septic shock is a devastating condition associated with high morbidity and mortality. Definitions for the sepsis continuum and treatment algorithms specific for premature neonates are needed to improve studies of septic shock and assess benefit from clinical interventions. Unique features of the immature immune system and pathophysiologic responses to sepsis, particularly those of extremely preterm infants, necessitate that clinical trials consider them as a separate group. Keen clinical suspicion and knowledge of risk factors will help to identify those neonates at greatest risk for development of septic shock. Genomic and proteomic approaches, particularly those that use very small sample volumes, will increase our understanding of the pathophysiology and direct the development of novel agents for prevention and treatment of severe sepsis and shock in the neonate. Although at present antimicrobial therapy and supportive care remain the foundation of treatment, in the future immunomodulatory agents are likely to improve outcomes for this vulnerable population.
Wynn
James L
JL
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University, 2424 Hock Plaza, Suite 504, DUMC Box 2739, Durham, NC 27710, USA. james.wynn@duke.edu <james.wynn@duke.edu>
Wong
Hector R
HR
D000209:Acute-Phase Proteins / Q000276:immunology; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000276:immunology / Q000503:physiopathology; D003165:Complement System Proteins / Q000276:immunology; D004730:Endothelium, Vascular / Q000276:immunology; D023281:Genomics / Q000379:methods; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007113:Immunity, Innate; D007112:Immunity, Maternally-Acquired; D007231:Infant, Newborn; D036341:Intercellular Signaling Peptides and Proteins / Q000276:immunology; D009102:Multiple Organ Failure / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D009504:Neutrophils / Q000276:immunology; D009895:Opsonin Proteins / Q000276:immunology; D040901:Proteomics / Q000379:methods; D012151:Resuscitation / Q000379:methods*; D012307:Risk Factors; D012772:Shock, Septic / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology* / Q000628:therapy*; D015398:Signal Transduction
D000209:Acute-Phase Proteins; D000890:Anti-Infective Agents; D036341:Intercellular Signaling Peptides and Proteins; D009895:Opsonin Proteins; D003165:Complement System Proteins; D006854:Hydrocortisone