Granulocyte Transfusions in Neonates
Harry R. Hill MD1
1 Professor of Pediatrics/Pathology, Head Division of Clinical Immunology/Allergy, Department of Pediatrics, University of Utah School of Medicine, 50 North Medical Dr, Salt Lake City, UT 84132
Human neonates, especially those born prematurely, are prone to developing overwhelming infections in response to bacterial pathogens. It is estimated that 1 to 8 per 1000 live births are complicated by such infections. Moreover, almost 30% of neonatal mortality and morbidity can be attributed to neonatal infection. Thus, in spite of all of the support measures offered in neonatal intensive care units and the use of new, potent antimicrobial agents, we continue to lose far too many infants to overwhelming infections. It is likely that we have come as far as we can with these accepted regimens for treating bacterial infection in the neonate. This has led many investigators to explore the possibility of using various forms of immunotherapy in neonates who have infections, because the neonatal host defense system is compromised significantly.
Most neonates who develop infection lack opsonic antibody to the infecting strain of bacteria. In addition, the infant complement system is compromised significantly with the concentration of most components being only approximately 50% of that of adults. Deficiency of antibody and complement lead to defective opsonization of most bacteria by neonatal serum. Additional consistent abnormalities in the neonatal host defense system are present in the cells that act as the first line of defense against bacterial invasion, polymorphonuclear leukocytes (PMNs), PMNs must arrive at the site of bacterial invasion within a very critical 2- to 4-hour period if infection is to be contained so that systemic spread does not occur.
