RISK OF INFECTION DURING ADRENOCORTICOTROPIC HORMONE-TREATMENT IN INFANTS WITH INFANTILE SPASMS

We reviewed the clinical features and laboratory findings of 27 infant s with infantile spasms treated with adrenocorticotropic hormone or pr ednisone during febrile episodes in order to evaluate the incidence of bacteremia, the risk of serious infection, determination of whether s erious infections can be identified at presentation and the outcome of febrile episodes. There were 75 febrile episodes including 4 episodes of identified bacteremia (5.3%). Three children who were treated with adrenocorticotropic hormone dosage larger than recommended died. Leuk ocytosis and a differential count with many immature granulocytes pred icted bacteremia in this population. Chest radiography was useful in i dentifying the cause of fever. The pathogens isolated were similar to those found in this age range. We conclude that the frequency of bacte remia in our patient population is similar to that observed in infants of the same age; however, the outcome is frequently fatal. In additio n this increased mortality may be associated with the use of a larger dosage of adrenocorticotropic hormone than recommended.