Recombinant human granulocyte colony-stimulating factor therapy for sepsis in infants with neutropenia.

Abstract

To the Editor. We have read with great interest the article “A randomized, placebo-controlled trial of granulocyte colony-stimulating factor administration to newborn infants with neutropenia and clinical signs of early-onset sepsis” published in the July 1998 issue of Pediatrics. 1 The results that granulocyte colony-stimulating factor (G-CSF) does not have a beneficial effect on the outcome in newborn infants with neutropenia and clinical signs of sepsis are not too surprising. Although prophylactic administration of G-CSF has a protective effect against the invasion of microorganisms in patients with neutropenia,2 in the clinical setting like this, one cannot help administrating G-CSF when sepsis becomes evident. Bone marrow myeloid progenitor cells are reduced and poor in response during overwhelming bacterial sepsis.3 A previous study showed that G-CSF given after bacterial inoculation failed to sustain the peripheral neutrophil count, and resulted in a high mortality rate.4 Furthermore, neutrophils are a source of several inflammatory mediators such as superoxide or destructive proteases capable of damaging the surrounding tissue. Neutrophil infiltration with resultant local destruction could also lead to the increased organ failure and death. Several studies have revealed the critical roles of …