A randomized, double-blind, placebo-controlled trial of prophylactic recombinant human granulocyte-macrophage colony-stimulating factor to reduce nosocomial infections in very low birth weight neonates

Objective: We carried out a randomized placebo-controlled trial in very low birth weight neonates (VLBWNs), comparing the incidence of nosocomial infe ctions after the prophylactic use of recombinant human granulocyte-macropha ge colony-stimulating factor (rhu GM-CSF) versus placebo in VLBWNs. Study design: VLBWNs (n = 264), weighing 501 to 1000 g, less than or equal to 72 hours of age were randomly assigned to receive rhu GM-CSF (8 mu g/kg/ d), administered intravenously (n = 134) over 2 hours daily x 7 days and ev ery other day for 21 days, or placebo (n = 130). The safety, incidence of n osocomial infections, days of absolute neutrophil count greater than or equ al to 4000/mm,(3) peripheral blood progenitor studies, and 24-hour polymorp honuclear leukocyte C3bi receptor expression were compared between the 2 tr eatment groups. Results: No (grade III/IV) toxicity or adverse events were associated with rhu GM-CSF The absolute neutrophil count and absolute eosinophil count were significantly elevated in the rhu GM-CSF group on days 7 (P =.001), 14 (P =.001), and 21 (P =.007) and on days 7 and 28 (P =.012 and P =.001, respect ively). However, there was no difference in the incidence of confirmed noso comial infections between the 2 treatment groups in this trial (40% vs 39%, rhu GM-CSF vs placebo; P = NS). Conclusion: In a large randomized placebo-controlled trial, prophylactic ad ministration of rhu GM-CSF in VLBWNs does not appear to decrease the incide nce of nosocomial infections.