Am J Perinatol 2017; 34(08): 795-800
DOI: 10.1055/s-0037-1598596
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pentoxifylline Treatment of Very Low Birth Weight Neonates with Nosocomial Sepsis

Şahin Hamilçıkan
1   Department of Pediatrics, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Emrah Can
1   Department of Pediatrics, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Övgü Büke
1   Department of Pediatrics, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Meltem Erol
1   Department of Pediatrics, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Özlem Bostan Gayret
1   Department of Pediatrics, Bagcılar Training and Research Hospital, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

02 December 2016

05 January 2017

Publication Date:
14 February 2017 (online)

Abstract

Objective The objective of this study was to assess the result of intravenous pentoxifylline as an adjunct to antibiotic therapy on mortality and morbidity in very low birth weight (VLBW) preterm neonates with nosocomial sepsis.

Methods For the 18 VLBW preterm neonates, as an adjunct therapy to antibiotics regimens, pentoxifylline (5 mg/kg/h for 6 hours) was administered to premature infants with sepsis on 3 successive days. Clinical and laboratory parameters were recorded before and after treatment.

Results Following pentoxifylline therapy, the immature-to-total neutrophil ratio and C-reactive protein (CRP) levels were significantly decreased, while the blood pH and base excess were significantly increased (p < 0.05). The axillary temperature, noninvasive blood pressure, hemoglobin, leukocyte, and thrombocyte values did not significantly differ after treatment (p > 0.05). Coagulase-negative staphylococci (CoNS) (32%), Streptococcus hominis (7.3%), Pseudomonas aeruginosa (5.3%), and Candida parapsilosis (3.1%) were identified in the blood cultures. There were no short-term morbidities (intraventricular hemorrhages, necrotizing enterocolitis, periventricular leukomalacia, and patent ductus arteriosus), no adverse effects, and no mortalities during or after the pentoxifylline therapy in the preterm neonate participants.

Conclusion The CRP levels and heart rate both decreased, while the pH and base excess parameters of the blood gas analysis changed positively after pentoxifylline treatment in VLBW preterm neonates with nosocomial sepsis.

Note

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and according to the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Şahin Hamilçıkan, Emrah Can, Meltem Erol, and Özlem Bostan Gayret made substantial contributions to the conception and design, acquisition of data or analysis and interpretation of data, drafting the article, and final approval of the version to be published. Övgü Büke helped in revising the article critically for important intellectual content and final approval of the version to be published.


 
  • References

  • 1 Salihoglu O, Can E, Koç MO, Durmus E, Hatipoglu S. Pentaglobin as an adjunct therapy in very low birthweight neonates with nosocomial sepsis. J Pak Med Assoc 2013; 63 (11) 1353-1357
  • 2 Harris E, Schulzke SM, Patole SK. Pentoxifylline in preterm neonates: a systematic review. Paediatr Drugs 2010; 12 (05) 301-311
  • 3 Kirschenbaum LA, Aziz M, Astiz ME, Saha DC, Rackow EC. Influence of rheologic changes and platelet-neutrophil interactions on cell filtration in sepsis. Am J Respir Crit Care Med 2000; 161 (05) 1602-1607
  • 4 Heath JA, Zerr DM. Infections acquired in the nursery: epidemiology and control. . In Remington JS, Klein JO, Wilson CB, Baker CJ. , eds. Infectious Diseases of the Fetus and Newborn Infant, 6 ed. Philadelphia, PA: Elsevier Saunders; 2006: 1179-1205
  • 5 Weinberg GA, D'Angio CT. Laboratory aids for diagnosis of neonatal sepsis. In Remington JS, Klein JO, Wilson CB, Baker CJ. , eds. Infectious Diseases of the Fetus and Newborn Infant, 6 ed. Philadelphia, PA: Elsevier Saunders; 2006: 1207-1222
  • 6 Carey AJ, Saiman L, Polin RA. Hospital-acquired infections in the NICU: epidemiology for the new millennium. Clin Perinatol 2008; 35 (01) 223-249 , x
  • 7 National Committee for Clinical Laboratory Standards. Analysis and presentation of cumulative antimicrobial susceptibility testing data; proposed guideline, M39-P. Wayne, PA : National Committee for Clinical Laboratory Standards; 2002
  • 8 American Academy of Pediatrics. Report of the committee on infectious disease 2007–2009 (ed. 28). Elk Grove Village, IL: American Academy of Pediatrics; 2009
  • 9 Palazzi DL, Klein JO, Baker CJ. Bacterial sepsis and meningitis. In Remington JS, Klein JO, Wilson CB, Baker CJ. , eds. Infectious Diseases of the Fetus and Newborn Infant, 6 ed. Philadelphia, PA: Elsevier Saunders; 2006: 247-295
  • 10 Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am 2004; 51 (04) 939-959 , viii–ix
  • 11 Cohen-Wolkowiez M, Benjamin Jr DK, Capparelli E. Immunotherapy in neonatal sepsis: advances in treatment and prophylaxis. Curr Opin Pediatr 2009; 21 (02) 177-181
  • 12 Brocklehurst P, Farrell B, King A. , et al; INIS Collaborative Group. Treatment of neonatal sepsis with intravenous immune globulin. N Engl J Med 2011; 365 (13) 1201-1211
  • 13 Ohlsson A, Lacy JB. Intravenous immunoglobulin for suspected or proven infection in neonates. Cochrane Database Syst Rev 2015; (03) CD001239 . Doi: 10.1002/14651858.CD001239.pub4
  • 14 Mohan P, Brocklehurst P. Granulocyte transfusions for neonates with confirmed or suspected sepsis and neutropaenia. Cochrane Database Syst Rev 2003; (04) CD003956 . Doi: 10.1002/14651858.CD003956.pub2
  • 15 Schibler KR, Osborne KA, Leung LY, Le TV, Baker SI, Thompson DD. A randomized, placebo-controlled trial of granulocyte colony-stimulating factor administration to newborn infants with neutropenia and clinical signs of early-onset sepsis. Pediatrics 1998; 102 (1 Pt 1): 6-13
  • 16 Lauterbach R, Pawlik D, Kowalczyk D, Ksycínski W, Helwich E, Zembala M. Effect of the immunomodulating agent, pentoxifylline, in the treatment of sepsis in prematurely delivered infants: a placebo-controlled, double-blind trial. Crit Care Med 1999; 27 (04) 807-814
  • 17 Pammi M, Haque KN. Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Cochrane Database Syst Rev 2015; (03) CD004205. . Doi: 10.1002/14651858.CD004205.pub3
  • 18 Staubach KH, Schröder J, Stüber F, Gehrke K, Traumann E, Zabel P. Effect of pentoxifylline in severe sepsis: results of a randomized, double-blind, placebo-controlled study. Arch Surg 1998; 133 (01) 94-100
  • 19 Shabaan AE, Nasef N, Shouman B, Nour I, Mesbah A, Abdel-Hady H. Pentoxifylline therapy for late-onset sepsis in preterm infants: a randomized controlled trial. Pediatr Infect Dis J 2015; 34 (06) e143-e148
  • 20 Bajčetić M, Spasić S, Spasojević I. Redox therapy in neonatal sepsis: reasons, targets, strategy, and agents. Shock 2014; 42 (03) 179-184
  • 21 Stoll BJ, Hansen N, Fanaroff AA. , et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1): 285-291
  • 22 Thaden JT, Ericson JE, Cross H. , et al; Antibacterial Resistance Leadership Group. Survival benefit of empirical therapy for staphylococcus aureus bloodstream infections in infants. Pediatr Infect Dis J 2015; 34 (11) 1175-1179
  • 23 Ericson JE, Thaden J, Cross HR. , et al; Antibacterial Resistance Leadership Group. No survival benefit with empirical vancomycin therapy for coagulase-negative staphylococcal bloodstream infections in infants. Pediatr Infect Dis J 2015; 34 (04) 371-375