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J Pediatr Infect Dis 2017; 12(03): 184-192
DOI: 10.1055/s-0037-1603331
Original Article
Georg Thieme Verlag KG Stuttgart · New York

White Blood Cell Changes Following Treatment with a Combination of Recombinant Human Granulocyte Colony Stimulating Factor (rhG-CSF) and Intravenous Immunoglobulin (IVIG) in Necrotizing Enterocolitis (NEC)

Prabhakar Kocherlakota
1   Department of Pediatrics, Division of Newborn Medicine, The Regional Neonatal Intensive Care Unit, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York, NY, United States
,
Sri K. P. Narayana
1   Department of Pediatrics, Division of Newborn Medicine, The Regional Neonatal Intensive Care Unit, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York, NY, United States
,
Jonathan Blau
2   Department of Pediatrics, Staten Island University Hospital, Staten Island, New York, NY, United States
,
Edmund F. La Gamma
1   Department of Pediatrics, Division of Newborn Medicine, The Regional Neonatal Intensive Care Unit, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York, NY, United States
› Author Affiliations
Further Information

Publication History

08 December 2016

28 December 2016

Publication Date:
30 May 2017 (online)

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Abstract

Objective We sought to determine whether recombinant human granulocyte colony stimulating factor (rhG-CSF) and intravenous immunoglobulin (IVIG) combination can increase white blood cell (WBC) count and improve the survival of extremely low-birth-weight (ELBW) neonates having necrotizing enterocolitis (NEC) with Bell stage II or above.

Methods This retrospective chart review consisted of ELBW neonates with NEC provided with standard of care (standard group) or standard of care and a combination of rhG-CSF along with IVIG (treated group) at the discretion of the treating physician. Serial blood counts (days 0,1,2,3, and 7 to 10), survival, need for surgical intervention, time to reach full feeds, and time to discharge were compared between the two groups.

Results The treated (27 neonates) and the standard (35 neonates) groups had birth weights of 857 ± 52 g and 1,009 ± 50 g; gestational ages of 26 ± 0.5 and 28 ± 0.5 weeks; WBC counts of 7,950 ± 6,452 and 14,105 ± 9,578/mm3; absolute neutrophil count (ANC) of 3,930 ± 5,152 and 7,117 ± 7,545/mm3, respectively (p < 0.05). During the study, WBC count and ANC increased in the treated group till days 7 to 10, but decreased till day 3 in the standard group (p < 0.05). ANC (11-fold) and monocytes (4-fold) increased in the treated patients with neutropenia by days 7 to 10 (p < 0.05). There was no change in the survival, need for surgery, time to reach full feed, or time to discharge between the two groups.

Conclusion The combination of rhG-CSF and IVIG increased WBC, ANC, and monocytes in the treated group but did not affect the survival, need for surgery, time to reach full feed, or time to discharge.

Keywords

absolute neutrophil count - intravenous immunoglobulin - neutropenia - necrotizing enterocolitis - recombinant human granulocyte colony stimulating factor

Contributors' Statement

Prabhakar Kocherlakota contributed to the design, acquired data, performed the initial analysis, drafted the manuscript, and approved the final manuscript as submitted.


Sri K.P. Narayanan acquired the data, performed the initial analysis, reviewed the initial manuscript, and approved the final manuscript as submitted.


Jonathan Blau acquired the data, performed the initial analysis, reviewed initial manuscript, and approved the final manuscript as submitted.


Edmund La Gamma conceptualized and designed the study, designed the data collection instruments, drafted the initial manuscript, and approved the final manuscript as submitted.


 

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