The Effect of Granulocyte-Macrophage Colony-Stimulating Factor on Neutropenia and Mortality in Neonatal Sepsis

Authors

  • Syed Arsalan Hassan Department of Pediatrics, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
  • Zeeshan Ahmed Department of Pediatrics, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
  • Uneeba Syed Department of Medicine, Services Hospital, Lahore Pakistan
  • Muhammad Tariq Nadeem Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Arshad Khushdil Department of Pediatrics, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v73i6.7456

Keywords:

Absolute neutrophil count, GM-CSF, Sepsis, Neonates, Platelet count, Total leukocyte count

Abstract

Objective: To evaluate the impact of adjuvant Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) therapy in
neonatal sepsis.

Study Design: Quasi-experimental study.

Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, Mar 2019 to Mar 2020.

Methodology: Thirty neonates (15 cases and 15 controls) were randomly selected for this study. The Interventional Group was given GM-CSF and standard-of-care treatment; the Control Group only received standard care. Both groups were followed for the primary outcome (i.e., discharge or death). Secondary outcomes included the effects of GM-CSF on haematological parameters of neonatal sepsis.

Results: The mean gestational age of the children was 33.46±2.47 weeks. In the Interventional-Group, 56.7% of the neonates were discharged with the resolution of the sepsis. There was no significant difference concerning the secondary outcome, but the mortality was higher in the neonates among the Control-Group (p-value>0.05).

Conclusion: Our study showed no difference in mortality between the Interventional and the Control Groups. The GM-CSF
therapy could be used as an adjuvant therapy in neonates with neonatal sepsis to increase the total leukocyte and absolute
neutrophil counts. Further studies are needed to holistically chart the clinical benefit of GM-CSF adjuvant therapy.

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References

Edwards MS, Baker CJ. Sepsis in the newborn, p545–561. In

Gershon AA, Hotez PJ, Katz SL. (ed), Krugman's infectious

diseases of children, 11th ed. Mosby, Philadelphia, 2004.

Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. EarlyOnset Neonatal Sepsis. Clin Microbiol Rev 2014; 27(1): 21–47.

https://doi.org/10.1128/cmr.00031-13.

World Health Organization. Neonatal Mortality. [Internet].

Available at https://www.who.int/news-room/fact-sheets/

(Accessed on January 28, 2022).

Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van

Meurs KP, et al. Early onset neonatal sepsis: the burden of group

B Streptococcal and E. coli disease continues. Pediatrics 2011;

(5): 817–826. https://doi.org/10.1542/peds.2010-2217

Ozkan H, Cetinkaya M, Koksal N, Celebi S, Hacımustafaoglu M.

Culture-proven neonatal sepsis in preterm infants in a neonatal

intensive care unit over a 7 year period: coagulase-negative

Staphylococcus as the predominant pathogen. Pediatr Int J Jpn

Pediatr Soc 2014; 56(1): 60–66.

https://doi.org/10.1111/ped.12218.

van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A,

Krediet TG. Long-Term Trends in the Epidemiology of Neonatal

Sepsis and Antibiotic Susceptibility of Causative Agents.

Neonatology 2010; 97(1): 22–28.

https://doi.org/10.1159/000226604.

Hoesel LM, Gao H, Ward PA. New insights into cellular

mechanisms during sepsis. Immunol Res 2006; 34(2): 133–41.

https://doi.org/10.1385/ir:34:2:133.

Odabasi IO, Bulbul A. Neonatal Sepsis. Med Bull Sisli Etfal Hosp

; 54(2): 142–158. https://doi.org/10.14744/semb.2020.00236.

Saboohi E, Saeed F, Khan RN, Khan MA. Immature to total

neutrophil ratio as an early indicator of early neonatal sepsis.

Pak J Med Sci 2019; 35(1): 241–246.

https://doi.org/10.12669/pjms.35.1.99.

Lieschke GJ, Burgess AW. Granulocyte Colony-Stimulating

Factor and Granulocyte-Macrophage Colony-Stimulating Factor.

N Engl J Med 1992; 327(2): 99–106.

https://doi.org/10.1056/nejm199207023270106.

Marlow N, Morris T, Brocklehurst P, Carr R, Cowan F,

Patel N, et al. A randomised trial of granulocyte-macrophage

colonystimulating factor for neonatal sepsis: childhood outcomes

at 5 years. Arch Dis Child Fetal Neonatal Ed 2015; 100(4): F320–

https://doi.org/10.1136/archdischild-2014-307410.

Bedford Russell AR, Emmerson AJ, Wilkinson N, Chant T,

Sweet DG, Halliday HL, et al. A trial of recombinant human

granulocyte colony stimulating factor for the treatment of very

low birthweight infants with presumed sepsis and neutropenia.

Arch Dis Child Fetal Neonatal Ed 2001; 84(3): F172-176.

https://doi.org/10.1136%2Ffn.84.3.F172.

Sung L, Nathan PC, Lange B, Beyene J, Buchanan GR.

Prophylactic granulocyte colony-stimulating factor and

granulocyte-macrophage colony-stimulating factor decrease

febrile neutropenia after chemotherapy in children with cancer: a

meta-analysis of randomized controlled trials. J Clin Oncol J Am

Soc Clin Oncol 2004; 22(16): 3350–3356.

https://doi.org/10.1200/jco.2004.09.106.

Carr R, Modi N, Doré C. G-CSF and GM-CSF for treating or

preventing neonatal infections. Cochrane Database Syst Rev

; (3): CD003066. https://doi.org/10.1002/14651858.cd003066

Lee JA, Sauer B, Tuminski W. Effectiveness of Granulocyte

Colony-Stimulating Factor in Hospitalized Infants with

Neutropenia. Am J Perinatol 2017; 34(5): 458-464.

https://doi.org/10.1055/s-0036-1593349.

Dale DC, Bolyard AA. An update on the diagnosis and treatment

of chronic idiopathic neutropenia. Curr Opin Hematol 2017;

(1): 46-53. https://doi.org/10.1097/MOH.0000000000000305.

Wan C, Yu HH, Lu MY, Lee JH, Wang LC, Lin YT, et al. Clinical

manifestations and outcomes of pediatric chronic neutropenia. J

Formos Med Assoc 2012; 111(4): 220-227.

https://doi.org/10.1016/j.jfma.2010.12.003.

Klaudel-Dreszler M, Pietrucha B, Skopczynska H, Pac M,

Kurenko-Deptuch M, Heropolitanska-Pliszka E, et al. Przewlekła

neutropenia - Doświadczena Własne Oddzialu Immunologii

Instytutu , Pomnik -Centrum Zdrowia Dziecka" w Warszawie z

Lat 1985-2006 [Chronic neutropenia-experience from the

Department of Immunology, Children's Memorial Health

Institute]. Med Wieku Rozwoj 2007; 11(2 Pt 1): 145-152.

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Published

28-12-2023

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Original Articles

How to Cite

1.
Hassan SA, Ahmed Z, Syed U, Nadeem MT, Khushdil A. The Effect of Granulocyte-Macrophage Colony-Stimulating Factor on Neutropenia and Mortality in Neonatal Sepsis. Pak Armed Forces Med J [Internet]. 2023 Dec. 28 [cited 2024 Dec. 12];73(6):1644-7. Available from: https://pafmj.org/PAFMJ/article/view/7456