Effect of granulocyte colony-stimulating factor on preeclampsia-associated neonatal neutropenia,☆☆,

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Abstract

Absolute neutropenia lasting longer than 72 hours after birth occurred in four very low birth weight neonates with a maternal history of severe pregnancy-induced hypertension, and was treated with recombinant granulocyte colony- stimulating factor for 3 days. Absolute neutrophil counts increased nearly fourfold within 48 hours; maximal values were recorded on the ninth day after the infusion was started. Total leukocyte counts subsequently decreased but remained in the normal range. It appears that recombinant human granulocyte colony-stimulating factor promotes a rapid increase in circulating neutrophils in these patients despite the possible presence of a circulating preeclampsia-associated inhibitor of neutrophil production. (J PEDIATR 1995;126:457-9)

Section snippets

CASE REPORTS

Three boys (536 gm, 593 gm, 905 gm) and one girl (637 gm) with gestational ages between 25 and 30 weeks were each delivered by cesarean section to women with severe preeclampsia (systolic blood pressures, 230 to 250 mm Hg; diastolic, 100 to 130 mm Hg). The hypertension was controlled with magnesium sulfate, hydralazine, and methyldopa. Neonatal management included mechanical ventilation, placement of vascular catheters, and empiric antibiotic therapy with ampicillin and gentamicin after culture

RESULTS

Granulocyte colony-stimulating factor was administered in three daily doses of 10 μg/kg per day8, 9, 10 as a 2- or 4-hour intravenous infusion in 2 or 4 ml of 0.2% albumin and 5% glucose water (final concentration, 5 μg/ml). The response to rhG-CSF was nearly identical in each case. The total neutrophil count increased nearly fourfold within 48 hours of the start of the administration of rhG-CSF, and peaked at a value nearly 15-fold higher (p <0.02) than at the initiation of therapy less than 1

DISCUSSION

Preeclampsia is the most commonly recognized condition associated with neonatal neutropenia; 6% of all pregnancies are complicated by pregnancy-induced hypertension, and nearly 50% of the infants delivered have an ANC below the lower limit of normal for postnatal age.1, 2, 3, 4, 5, 6, 7 The significant hematopoietic response that we observed in our patients indicates that VLBW neonates who are at increased risk of having an infection because of their persistent neutropenia may benefit from

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From the Department of Pediatrics and Neurobiology, State University of New York at Stony Brook

☆☆

Reprint requests: Edmund F. La Gamma, MD, Pediatrics/Neurobiology, State University of New York HSC 11-060, Stony Brook NY 11794-8111.

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