title: Pentoxifylline therapy for late-onset sepsis in preterm infants: a randomized controlled trial.
abstract: BACKGROUND
  The role of pentoxifylline (PTX) in reducing mortality associated with neonatal sepsis is not well established. We aimed to assess the efficacy and safety of PTX as an adjunct to antibiotics on mortality and morbidity in preterm infants with late-onset sepsis (LOS).
  
  
  METHODS
  Double blind, randomized controlled trial was conducted on 120 preterm infants with LOS. They were randomly assigned to receive either intravenous PTX 5 mg/kg/hr for 6 hours on 6 successive days or placebo. Death before hospital discharge was our primary outcome and secondary outcomes were length of hospital stay, duration of respiratory support, duration of antibiotics use, short-term morbidity of preterm infants, tumor necrosis factor-alpha concentrations, C-reactive protein concentrations, and adverse effects of PTX.
  
  
  RESULTS
  A total of 120 infants were enrolled, 60 in each group, 78 (65%) infants had confirmed and 42 (35%) had suspected LOS. There were no significant differences between groups regarding mortality [6 (10%) in PTX vs. 10 (16.5%) in placebo, P = 0.44], short-term morbidity and combined mortality and/or short-term morbidity [18 (30%) vs. 24 (40%), P = 0.23]. PTX therapy was associated with significant reduction of serum tumor necrosis factor-alpha and C-reactive protein concentrations. The length of hospital stay, durations of respiratory support and antibiotic therapy were significantly shorter in the PTX group. Patients in PTX group had less need for vasopressors, lower incidence of metabolic acidosis, disseminated intravascular coagulopathy and thrombocytopenia. No adverse effects to PTX were reported.
  
  
  CONCLUSIONS
  PTX has a beneficial adjuvant effect to antibiotic therapy in preterm infants with LOS without significant impact on neonatal mortality and morbidity.
authors.affiliation: *Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt; and †Department of Clinical Pathology, Faculty of medicine, Mansoura, Egypt.
authors.forename: Abd Elazeez
authors.initials: AE
authors.lastname: Shabaan
authors.forename: Nehad
authors.initials: N
authors.lastname: Nasef
authors.forename: Basma
authors.initials: B
authors.lastname: Shouman
authors.forename: Islam
authors.initials: I
authors.lastname: Nour
authors.forename: Abeer
authors.initials: A
authors.lastname: Mesbah
authors.forename: Hesham
authors.initials: H
authors.lastname: Abdel-Hady
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D007231:Infant, Newborn; D007234:Infant, Premature; D000067562:Late Onset Disorders / Q000188:drug therapy*; D007902:Length of Stay; D008297:Male; D010431:Pentoxifylline / Q000008:administration & dosage* / Q000009:adverse effects; D010919:Placebos / Q000008:administration & dosage; D018805:Sepsis / Q000188:drug therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D007155:Immunologic Factors; D010919:Placebos; D010431:Pentoxifylline