Immunotherapy of neonatal septicemia.
This chapter has reviewed the deficiencies in immune defense that place the neonate, particularly the premature infant, at increased risk of invasive bacterial disease. We also have reviewed the literature on the rationale for exchange transfusion, granulocyte transfusion, intravenous immunoglobulin, and fibronectin administration as immunotherapeutic agents in infected infants. There have been no randomized controlled trials of exchange transfusion, immunoglobulin, or fibronectin administration in human infants with infection. Granulocyte transfusion in the infected newborn infant has been studied in a controlled fashion, but the results of clinical trials are conflicting. Thus, all of these interventions appear to need further evaluation. We therefore recommend that in the septic newborn infant with neutropenia and an I/T ratio greater than or equal to 0.8, who fails to demonstrate a favorable response to conventional antibacterial chemotherapy and cardiopulmonary support, the administration of approximately 1 X 10(9) irradiated granulocytes per kg may be beneficial. In the absence of equipment to isolate the granulocytes, a double-volume exchange transfusion with fresh heparinized whole blood will provide a similar quantity of functional phagocytes.