Neutropenia in an extremely premature infant treated with recombinant human granulocyte colony-stimulating factor
R. L. Roberts, C. M. Szelc, S. M. Scates, M. T. Boyd, K. M. Soderstrom, M. W. Davis and J. A. Glaspy
Department of Pediatrics, UCLA Medical Center 90024.
Neutropenia in the newborn is often associated with sepsis, maternal
hypertension, or prematurity. We describe a 654-g infant born at 30 weeks'
gestation by cesarean section due to severe maternal hypertension. His
course was complicated by five episodes of sepsis, including three with
group B streptococcus. The results of hematologic and immunologic studies
were normal except that absolute neutrophil counts were low (less than 1 x
10(9)/L) with intermittent increases during sepsis. Human recombinant
granulocyte colony-stimulating factor administered subcutaneously (10
micrograms/kg per day initially) resulted in an absolute neutrophil count
of greater than 30 x 10(9)/L within 2 weeks. The dosage was lowered and the
absolute neutrophil counts were maintained at 8 to 12 x 10(9)/L with no
further septic episodes. The human recombinant granulocyte
colony-stimulating factor therapy was discontinued after 7 months, and the
patient remained healthy with an absolute neutrophil count of greater than
2 x 10(9)/L. Thus, treatment with human recombinant granulocyte
colony-stimulating factor may be useful as a temporary measure for neonatal
neutropenia associated with sepsis. A controlled, clinical trial is
warranted.
