Adjunctive immunologic interventions in neonatal sepsis.
Because of inadequate sample sizes of randomized controlled trials, few immunologic interventions to treat or prevent neonatal sepsis have been reliably evaluated. International collaboration is essential in achieving timely, adequate samples to assess effects on mortality or disability-free survival reliably. Promising or possible therapeutic interventions in severe or gram-negative sepsis include exchange transfusions, pentoxifylline, and IgM-enriched intravenous immunoglobulin. Promising or possible prophylactic interventions include lactoferrin, with or without a probiotic; selenium; early curtailment of antibiotics after sterile cultures; breast milk; and earlier initiation of colostrum in high risk preterm infants. Prophylactic oral probiotics are safe and effective (P<.00001) in reducing all-cause mortality and necrotizing enterocolitis in preterm infants by over half, but do not reduce sepsis.
Tarnow-Mordi
William
W
Westmead International Network for Neonatal Education and Research (WINNER) Institute, Centre for Newborn Care, Westmead Hospital, University of Sydney, Hawkesbury Road, New South Wales 2145, Australia. williamtm@med.usyd.edu.au <williamtm@med.usyd.edu.au>
Isaacs
David
D
Dutta
Sourabh
S
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001942:Breast Feeding; D005078:Exchange Transfusion, Whole Blood; D005973:Glutamine / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007231:Infant, Newborn; D007781:Lactoferrin / Q000627:therapeutic use; D018384:Oxidative Stress; D010431:Pentoxifylline / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D011486:Protein C / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012643:Selenium / Q000627:therapeutic use; D018805:Sepsis / Q000276:immunology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous; D011486:Protein C; D005973:Glutamine; D007781:Lactoferrin; D012643:Selenium; D010431:Pentoxifylline