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- Title
Effect on Absolute Neutrophil Count Using-CSF in Neutropenic Septic Neonates and Its Relation With Outcome Specially Mortality.
- Authors
Bala, Harsh; Bathla, Vikas; Malvia, Sunny
- Abstract
Objective: To study effect of supplementing G-CSF to septic neonates with ANC<5000/cmm in terms of 1. Increase in Absolute Neutrophi Count (ANC) 2. Effect of increase ANC count on outcome especially mortality Material And Method: Prospective observational study in division of neonatology of pediatrics Department, Pacific Medical College and Hospital, Udaipur from September 2022 to September 2023. Inclusion Criteria: 1. Septic neonate 2. ANC <5000/cmm 3. Evidence of sepsis i.e., at least one positive blood culture in neonatal period Methodology: Written consent from guardians of neonates were taken. Ethical clearance was taken, Necessary laboratory investigations were done and blood culture was taken by proper method. Antibiotic and appropriate treatment was initiated as per NICU unit protocol. Standard hematological techniques were employed for estimation of hematological parameters. Result: The study was carried out in 40 septic neutropenic preterm neonates with ANC<5000/cmm. They were randomly assigned to treatment group(n=20) and control group (n=20). There was male preponderance with 60% of babies were male. Age of neonate at study entry was comparable between G-CSF and control group [6.5 ± 2.98 days Vs 6.0 ± 5.38 days (p>0.05)]. With administration of G-CSF, ANC rose to significantly higher level with G-CSF group as compared to control group on day 3 (4786±1089/cmm Vs 4212±754/cmm, p<0.05). The rise was sustained till day 5 (5008±1028/cmm Vs 4055±522/cmm, p<0.01). However by day 7, ANC was comparable between two groups. (5077±657/cmm Vs 4652±779/cmm. p>0.05). ANC reached peak value on day 7 in G-CSF group. Mortality was significantly higher in control group compared G-CSF group (35% Vs 15%, p<0.05). Stepwise regression analysis revealed no significant correlation between G-CSF use and mortality. Only predictable factor affecting mortality significantly was ANC not recovering to >5000/cmm by day 7. Other factors like birth weight, IVH, meningitis, ANC recovering to >5000/cmm by day 7 and blood culture sterility by day 6 were not found to correlate significantly with mortality. Clinical symptoms of sepsis like gastrointestinal symptoms and hypoglycemia were resolved earlier in G-CSF group as compared to control group (4.71±2.3 Vs 8.0±4.2 days, p<0.05) and (4.0±1.0 Vs 7.0±1.78 days, p<0.01 respectively). Conclusion: G-CSF use in preterm septic neonates with Birth weight (900-1900 gm, mean 1345±289 gm) and Gestational age (28-36 weeks, mean 31.5±2.68 weeks) increased absolute neutrophil count and resulted in decrease in mortality. Mortality was more in patients in whom ANC did not rise >5000/cmm by D7. However, studies with large number of patients are warranted before use of G-CSF can be recommended as standard therapy for preterm neutropenic septic neonates.
- Subjects
JAIPUR (India); NEWBORN infants; NEONATAL sepsis; BIRTH weight; NEUTROPHILS; MORTALITY; GESTATIONAL age
- Publication
Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research), 2023, Vol 14, Issue 10, p1604
- ISSN
0975-3583
- Publication type
Article