title: Polymyxin B-immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome.
abstract: BACKGROUND
  There have been no previous studies regarding whether combined use of Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) and continuous hemodiafiltration (CHDF) is helpful in the treatment of preterm infants with systemic inflammatory response syndrome (SIRS) and hypercytokinemia.
  
  
  METHODS
  A retrospective review was carried out of 18 SIRS infants born at gestational week 24-28. Eight with blood interleukin (IL)-6 ≥ 1000 pg/mL were treated actively with 2 h PMX-DHP followed by 2 h PMX-DHP and CHDF. Ten with IL-6 < 500 pg/mL were treated conventionally (with neither PMX-DHP nor CHDF) and served as controls.
  
  
  RESULTS
  Demographic characteristics were similar except for IL-6, arterial-to-alveolar oxygen tension ratio (a/APO2), and number of immature neutrophils between the two groups. Baseline a/APO2was significantly lower in infants with than without active treatment (0.44 vs 0.67, respectively, P = 0.002). After 4 h treatment, the IL-6 decreased to < 500 pg/mL in all eight infants, and a/APO2improved significantly to 0.62 (P = 0.006). Bronchopulmonary dysplasia occurred in a similar proportion (63%, 5/8 vs 80%, 8/10, respectively), but the number of days on inhaled oxygen (30 vs 47 days, respectively, P = 0.033) and tracheal intubation (36 vs 51 days, respectively, P = 0.040) was significantly lower in infants with than without active treatment. Prevalence of adverse events was similar (13%, 1/8 vs 50%, 5/10 for active vs conventional treatment, respectively).
  
  
  CONCLUSIONS
  Active treatment with PMX-DHP and CHDF was helpful in the reduction of days on inhaled oxygen and tracheal intubation in preterm SIRS infants with hypercytokinemia. Further prospective randomized studies are warranted.
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maede
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ibara
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Tokuhisa
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Ishihara
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hirakawa
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Fukuda Hospital, Kumamoto, Japan.
authors.forename: Daijiro
authors.initials: D
authors.lastname: Takahashi
authors.affiliation: Department of Neonatology, Perinatal Medical Center, Fukuda Hospital, Kumamoto, Japan.
authors.forename: Seiro
authors.initials: S
authors.lastname: Machigashira
authors.affiliation: Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000379:methods*; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D015850:Interleukin-6 / Q000097:blood* / Q000172:deficiency; D008297:Male; D011112:Polymyxin B; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D011112:Polymyxin B
keywords: coagulation-fibrinolysis; necrotizing enterocolitis; retinopathy of prematurity; systemic inflammatory response syndrome; tracheomalacia