Myeloid colony-stimulating factors - Use in the newborn

Bacterial and fungal sepsis are major causes of morbidity and mortality in the newborn. Multiple factors contribute to this increased susceptibility t o infection, including quantitative and qualitative neutrophil defects, wit h a reduction in neutrophil number and function. Neutropenia in the newborn may occur in association with sepsis and has a poor prognosis. In addition to antibiotic therapy and supportive care, granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF ) have been used to reduce morbidity and mortality. Granulocyte CSF is the physiological regulator of neutrophil production and function. Administrati on of G-CSF results in increased neutrophil production and counts and impro ved neutrophil function. Several studies of animal and human newborns havin g neutropenia or suspected sepsis investigated the use of G-CSF and GM-CSF to elevate neutrophil counts and reduce morbidity and mortality in this pop ulation. Results of small clinical trials using G-CSF and GM-CSF in very lo w-birth-weight infants having neutropenia show increased neutrophil counts and a reduced incidence of sepsis during the neonatal period. Despite these promising early results, further studies of the safety and efficacy of G-C SF and GM-CSF administration in neonates are required before their routine use can be recommended as either prophylaxis or treatment for neonatal seps is.