PEDIATRICS Vol. 74 No. 5 November 1984, pp. 887-892
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Improved Survival of Newborns Receiving Leukocyte Transfusions for Sepsis

Mitchell S. Cairo MD1, Ralph Rucker MD1, Geni A. Bennetts MD1, David Hicks MD1, Carrie Worcester MD1, Ragnar Amlie MD1, Stephen Johnson MD1, and Jacob Katz MD1

1 From the Department of Pediatrics, Childrens Hospital of Orange County, University of California, Irvine

To determine the role of polymorphonuclear (PMN) leukocyte transfusions in neonates with sepsis, 23 consecutive newborns were prospectively randomly selected during an 18-month period in a treatment Plan to receive polymorphonuclear leukocyte transfusions with supportive care or supportive care alone. Thirteen neonates received transfusions every 12 hours for a total of five transfusions. Each transfusion consisting of 15 mL/kg of polymorphonuclear leukocytes was subjected to 1,500 rads of radiation. The polymorphonuclear leukocytes were obtained by continuous-flow centrifugation leukapheresis and contained 0.5 to 1.0 x 109 granulocytes per 15 mL with less than 10% lymphocytes. Pretreatment demographic, clinical, and laboratory variables that were found to be insignificant in prognosis between newborns who received transfusions and newborns who did not receive transfusions included weight, gestational and postnatal age, hypoxia, acidosis, hypotension, initial absolute granulocyte count (AGC), initial levels of immunoglobulins (IgA, IgG, and IgM), and total hemolytic complement. Positive findings on blood cultures were obtained in 14/23 patients and even were randomly selected for each treatment group. Absolute granulocyte counts were <1,500/µL in 13 patients but tibial bone marrow examinations revealed that the neutrophil supply pool was depleted in only three patients. The survival was significantly greater in the treatment group (13/13, 100%) compared with the group that did not receive transfusions (6/10, 60%, P < .02). There were no unto-ward effects attributable to the polymorphonuclear leukocyte transfusions during the study or on subsequent follow-up clinic visits. These preliminary data suggest that the use of adult donor polymorphonuclear leukocytes in the early treatment of proven or clinically suspected newborns with sepsis lowers mortality of neonatal sepsis.

Key Words: neonatal • sepsis • leukocyte • transfusions • neutrophil supply pool depletion

Submitted on March 23, 1984
Accepted on June 18, 1984




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