Review: Deficiencies in the neutrophil system of newborn infants, and the use of leukocyte transfusions in the treatment of neonatal sepsis

Abstract

Bacterial sepsis is a major cause of morbidity and mortality in the neonatal period. Deficiencies in neutrophil chemotaxis, phagocytosis, and bacterial killing have all been proposed as factors possibly responsible for this problem. In addition, the neutrophil storage pool, or all segmented neutrophils, band neutrophils, and metamyelocytes/kg body weight stored within the marrow, appears to be very small in neonates compared to that in adults, and when an infection develops in a neonate, neutrophil production from stem cells may be limited. In this paper we review the evidence for these neonatal neutrophil deficiencies and examine the animal and clinical studies which have tested leukocyte transfusion as a possible adjunctive therapeutic modality for sepsis neonatorum.

A 4-year prospective study of septicemia in pediatric surgical patients at a tertiary care teaching hospital in Kuwait

“…In one retrospective study by Bhattacharya et al [13] on a group of 608 patients from the pediatric surgical department for a 14-month period, 14 patients (2.3%) developed septicemia. Neonates in this study were at an increased risk for septicemia (4.2%) compared to older children and infants (3.1%) [13], which could be attributed to impaired host defenses of neonates [14][15][16]. In general, the data presented in this report were comparable to other reports [13][14][15][16].…”

“…Neonates in this study were at an increased risk for septicemia (4.2%) compared to older children and infants (3.1%) [13], which could be attributed to impaired host defenses of neonates [14][15][16]. In general, the data presented in this report were comparable to other reports [13][14][15][16]. In our study, neonates and infants 6 months or younger accounted for most of the 40% and 36% of patients, respectively.…”

Granulocytes

“…70 A contributing factor to this high mortality is relative dysfunction of neonatal neutrophils, cells that have been shown to exhibit quantitative abnormalities in chemotaxis, adhesion, and oxidative metabolism. 73 The efficacy of granulocyte transfusion therapy in the setting of neonatal sepsis was evaluated in six controlled trials [74][75][76][77][78][79] and reviewed by Strauss. 73 The efficacy of granulocyte transfusion therapy in the setting of neonatal sepsis was evaluated in six controlled trials [74][75][76][77][78][79] and reviewed by Strauss.…”

Current Issues in Neonatal Transfusions

“…The mechanism of neutropenia cannot always be defined, but m some infants a marked decrease in the neutrophil storage pool (NSP) of the bone marrow can be demonstrated [16][17][18]. The NSP consists of the postmi totic neutrophils (mature, segmented neutrophils plus all types of metamyelocytes such as bands and stabs).…”

“…Neonates most likely to benefit from granulocyte transfusions are those with markedly diminished NSP [17][18][19], Obviously, it is impractical, when considering granulocyte transfusion therapy, to always perform bone marrow examinations on neonates with presumed sepsis and absolute neutrophil counts <3,000/pl. Although the total absolute blood neutrophil count will not accurately predict the status of the NSP in the bone marrow, the differential white blood cell count may be helpful [19].…”