title: Exchange Transfusion in the Treatment of Neonatal Septic Shock: A Ten-Year Experience in a Neonatal Intensive Care Unit.
abstract: Septic shock, occurring in about 1% of neonates hospitalized in neonatal intensive care unit (NICU), is a major cause of death in the neonatal period. In the 1980s and 90s, exchange transfusion (ET) was reported by some authors to be effective in the treatment of neonatal sepsis and septic shock. The main aim of this retrospective study was to compare the mortality rate of neonates with septic shock treated only with standard care therapy (ScT group) with the mortality rate of those treated with ScT and ET (ET group). All neonates with septic shock admitted to our NICU from 2005 to 2015 were included in the study. Overall, 101/9030 (1.1%) neonates had septic shock. Fifty neonates out of 101 (49.5%) received one or more ETs. The mortality rate was 36% in the ET group and 51% in the ScT group (p = 0.16). At multivariate logistic regression analysis, controlling for potentially confounding factors significantly associated with death (gestational age, serum lactate, inotropic drugs, oligoanuria), ET showed a marked protective effect (Odds Ratio 0.21, 95% Confidence Interval: 0.06-0.71; p = 0.01). The lack of observed adverse events should encourage the use of this procedure in the treatment of neonates with septic shock.
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. lorenza.pugni@mangiagalli.it.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pugni
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. andrea.ronchi@mangiagalli.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ronchi
authors.affiliation: Neonatal Intensive Care Unit, Department of Pediatrics and Child Neuropsychiatry, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy. bizzarribianca@gmail.com.
authors.forename: Bianca
authors.initials: B
authors.lastname: Bizzarri
authors.affiliation: Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. dario.consonni@unimi.it.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. carlo.pietrasanta@gmail.com.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pietrasanta
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. beaghiro@hotmail.com.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ghirardi
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. monica.fumagalli@mangiagalli.it.
authors.forename: Monica
authors.initials: M
authors.lastname: Fumagalli
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. stefano.ghirardello@mangiagalli.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghirardello
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 12, 20122 Milan, Italy. fabio.mosca@unimi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
mesh_terms: D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008297:Male; D000071074:Neonatal Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*
keywords: exchange transfusion; neonatal infection; neonatal sepsis; neonatal septic shock; neonate; preterm infant; therapy of septic shock