Effectiveness of Granulocyte Colony-Stimulating Factor in Hospitalized Infants with Neutropenia

Jin A. Lee; Brooke Sauer; William Tuminski; Jiyu Cheong; John Fitz-Henley II; Megan Mayers; Chidera Ezuma-Igwe; Christopher Arnold; Christoph P. Hornik; Reese H. Clark; Daniel K. Benjamin Jr.; P. Brian Smith; Jessica E. Ericson; on behalf of the Best Pharmaceuticals for Children Act—Pediatric Trials Network Steering Committee

doi:10.1055/s-0036-1593349

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2017; 34(05): 458-464
DOI: 10.1055/s-0036-1593349

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effectiveness of Granulocyte Colony-Stimulating Factor in Hospitalized Infants with Neutropenia

Jin A. Lee

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

²Boramae Hospital, Seoul National University, Seoul, South Korea

³College of Medicine, Seoul National University, Seoul, South Korea

,

Brooke Sauer

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

,

William Tuminski

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

,

Jiyu Cheong

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

,

John Fitz-Henley II

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

,

Megan Mayers

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

,

Chidera Ezuma-Igwe

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

,

Christopher Arnold

⁴Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia

,

Christoph P. Hornik

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

⁵Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina

,

Reese H. Clark

⁶Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida

,

Daniel K. Benjamin Jr.

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

⁵Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina

,

P. Brian Smith

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

⁵Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina

,

Jessica E. Ericson

¹Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

⁷Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania

,

on behalf of the Best Pharmaceuticals for Children Act—Pediatric Trials Network Steering Committee

› Institutsangaben

Abstract

Objective The objective of this study was to determine the time to hematologic recovery and the incidence of secondary sepsis and mortality among neutropenic infants treated or not treated with granulocyte colony-stimulating factor (G-CSF).

Study Design We identified all neutropenic infants discharged from 348 neonatal intensive care units from 1997 to 2012. Neutropenia was defined as an absolute neutrophil count ≤ 1,500/µL for ≥ 1 day during the first 120 days of life. Incidence of secondary sepsis and mortality and number of days required to reach an absolute neutrophil count > 1,500/µL for infants exposed to G-CSF were compared with those of unexposed infants.

Results We identified 30,705 neutropenic infants, including 2,142 infants (7%) treated with G-CSF. Treated infants had a shorter adjusted time to hematologic recovery (hazard ratio: 1.36, 95% confidence interval [CI]: 1.30–1.44) and higher adjusted odds of secondary sepsis (odds ratio [OR]: 1.50, 95% CI: 1.20–1.87), death (OR: 1.33, 95% CI: 1.05–1.68), and the combined outcome of sepsis or death (OR: 1.41, 95% CI: 1.19–1.67) at day 14 compared with untreated infants. These differences persisted at day 28.

Conclusion G-CSF treatment decreased the time to hematologic recovery but was associated with increased odds of secondary sepsis and mortality in neutropenic infants. G-CSF should not routinely be used for infants with neutropenia.

Keywords

hematologic recovery - sepsis - prophylaxis

Volltext

Referenzen

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