Уважаемый Dr. Vad !
Лично мне не известны работы, однозначно подтверждающие эффективность granulocyte colony-stimulating factor при лечении сепсиса с нейтропенией у новорожденных (включая недоношенных). В нашей клинике за последние несколько лет он использовался для этой цели лишь однажды в случае сепсиса со стойкой нейтропенией у глубоко недоношенного ребенка.Тогда нейтропения исчезла в течение нескольких дней. Как вы прекрасно понимаете, этого наблюдения не достаточно для оценки его эффективности. Следует также отметить, что некоторые известные нежелательные эффекты granulocyte colony-stimulating factor, например, тромбоцитопения, существенно ограничивают его применение при тяжелых формах сепсиса у новорожденных\недоношенных детей.
При этом рациональная антибиотикотерапия является высокоэффективным методом лечения сепсиса и в подавляющем большинстве случаев приводит к излечению даже у детей, рожденных на 24-25 неделях беременности. Думаю, что при правильно поставленной диагностике и своевременно назначенном антибактрериальном лечении в принципе новорожденные не должны умирать от бактериальных осложнений.
В заключение позволю себе привести ряд ссылок, которые, возможно, вас заинтересуют ( если вы хотите получить full text напишите мне об этом).
1. A randomized, double-masked, placebo-controlled trial of recombinant granulocyte colony-stimulating factor administration to preterm infants with the clinical diagnosis of early-onset sepsis.
Miura E - Pediatrics - 01-JAN-2001; 107(1): 30-5
From NIH/NLM MEDLINE
Department of Pediatrics, Division of Neonatology, Hospital de Clínicas de Porto Alegre, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Abstract:
OBJECTIVE: We performed a randomized, double-masked, parallel-groups, placebo-controlled trial of recombinant granulocyte colony-stimulating factor (rG-CSF) administration to 44 preterm neonates who had blood cultures obtained and antibiotics begun because of the clinical diagnosis of early-onset sepsis. Two primary outcome variables were tested 1) mortality and 2) development of nosocomial infections over the 2-week period after dosing. DESIGN AND METHODS: The treatment group (n = 22) received 10 microgram/kg/day of intravenous rG-CSF once daily for 3 days and the placebo group (n = 22) received the same volume of a visually indistinguishable vehicle. Mortality and culture-proven nosocomial infections were recorded. Immediately before the first, second, and third doses, and again 10 days after the first dose, serum concentrations were determined for tumor necrosis factor-alpha, interleukin 6, granulocyte-macrophage colony stimulating factor, and G-CSF, and blood leukocyte counts, absolute neutrophil counts, immature/total neutrophil ratios, platelet counts, and hemoglobin concentrations were measured. RESULTS: The treatment and placebo groups were of similar gestational age (29 +/- 3 vs 31 +/- 3 weeks) and birth weight (1376 +/- 491 vs 1404 +/- 508 g), and had similar Apgar scores and 24-hour Score for Neonatal Acute Physiology scores. The mortality rate was not different between treatment and placebo groups. However, the occurrence of a subsequent nosocomial infection was lower in the rG-CSF recipients (relative risk:.19; 95% confidence interval:.05-.78). rG-CSF treatment did not alter the serum concentrations of the cytokines measured (except for G-CSF). Serum G-CSF levels and blood neutrophil counts were higher in the treatment than in the placebo group 24 hours and 48 hours after dosing. CONCLUSIONS: Administration of 3 daily doses of rG-CSF (10 microgram/kg/day) to premature neonates with the clinical diagnosis of early-onset sepsis did not improve mortality but was associated with acquiring fewer nosocomial infections over the subsequent 2 weeks.
2.Administration of recombinant granulocyte colony-stimulating factor to neonates with septicemia: A meta-analysis.
Bernstein HM - J Pediatr - 01-JUN-2001; 138(6): 917-20
From NIH/NLM MEDLINE
Author Affiliation:
Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Abstract:
A meta-analysis was used to determine whether administering recombinant granulocyte colony-stimulating factor (rG-CSF) to neonates with bacterial septicemia reduces mortality. Five studies were identified, involving 73 rG-CSF recipients and 82 control subjects. Mortality was lower among the rG-CSF recipients (odds ratio, 0.17; CI, 0.03-0.70; P <.05). However, when the non-randomized studies were excluded, the P value was.13. For the subgroups "<2000 g" or "neutropenia," the P value was <.02. Thus the routine use of rG-CSF cannot be recommended for all neonates with sepsis.