Pediatric Pharmacotherapy by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030504946
Publisher: Springer International Publishing

1.4 Other Proposed Uses for rG-CSF in the NICU

rG-CSF has been tested as a neuroprotectant in a rodent model of neonatal hypoxic-ischemic brain damage. Subcutaneous G-CSF administration, beginning 1 h after the injury, prevented brain atrophy, preserved reflexes, and improved motor coordination and memory. In addition, animals treated with G-CSF had better somatic growth (Fathali et al. 2010).

G-CSF is found in amniotic fluid, which is swallowed by the fetus in large quantities, up to 200 mL/k/day. The G-CSF swallowed binds to receptors on enterocytes and conveys antiapoptotic actions (Gersting et al. 2004). A sterile, isotonic, simulated amniotic fluid containing rG-CSF has been administered to NICU patients who are otherwise NPO (nil per os) with the hypothesis that such will prevent disuse atrophy of the intestinal villi that otherwise occurs during the NPO period. Safety and early efficacy studies of this approach seem promising (Sullivan et al. 2002; Christensen et al. 2005; Barney et al. 2007).

rG-CSF and rGM-CSF have both been examined as means of prophylaxis against nosocomial infections in VLBW neonates. A large multicentered, randomized trial by Carr et al. (2009) involved 280 neonates ≤31 weeks gestation, and <10th percentile for birth weight were randomized within 72 h of birth to receive GM-CSF 10 μg/k/day subcutaneously for 5 days or standard management. The primary outcome was sepsis-free survival 14 days from trial entry. They observed a significant increase in blood neutrophil count in the GM-CSF recipients, but no difference in sepsis-free short-term survival.

Aktas et al. from Istanbul reported a randomized trial of G-CSF plus antibiotics vs. antibiotics alone among 56 neutropenic preterm infants with proven or suspected sepsis. The neutrophil count was significantly higher on the second and third study day in the G-CSF recipients, but the mortality rate was unaffected (Aktaş et al. 2015).

The current consensus is that rG-CSF and rGM-CSF should not be used routinely in NICUs for prophylaxis against nosocomial infections because the evidence for such usage is at best very weak.

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