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- Title
Polymyxin B-immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome.
- Authors
Maede, Yoshinobu; Ibara, Satoshi; Tokuhisa, Takuya; Ishihara, Chie; Hirakawa, Eiji; Matsui, Takako; Takahashi, Daijiro; Machigashira, Seiro; Minakami, Hisanori
- Abstract
Background There have been no previous studies regarding whether combined use of Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) and continuous hemodiafiltration (CHDF) is helpful in the treatment of preterm infants with systemic inflammatory response syndrome (SIRS) and hypercytokinemia. Methods A retrospective review was carried out of 18 SIRS infants born at gestational week 24-28. Eight with blood interleukin (IL)-6 ≥ 1000 pg/mL were treated actively with 2 h PMX-DHP followed by 2 h PMX-DHP and CHDF. Ten with IL-6 < 500 pg/mL were treated conventionally (with neither PMX-DHP nor CHDF) and served as controls. Results Demographic characteristics were similar except for IL-6, arterial-to-alveolar oxygen tension ratio (a/APO2), and number of immature neutrophils between the two groups. Baseline a/APO2 was significantly lower in infants with than without active treatment (0.44 vs 0.67, respectively, P = 0.002). After 4 h treatment, the IL-6 decreased to < 500 pg/mL in all eight infants, and a/APO2 improved significantly to 0.62 ( P = 0.006). Bronchopulmonary dysplasia occurred in a similar proportion (63%, 5/8 vs 80%, 8/10, respectively), but the number of days on inhaled oxygen (30 vs 47 days, respectively, P = 0.033) and tracheal intubation (36 vs 51 days, respectively, P = 0.040) was significantly lower in infants with than without active treatment. Prevalence of adverse events was similar (13%, 1/8 vs 50%, 5/10 for active vs conventional treatment, respectively). Conclusion Active treatment with PMX-DHP and CHDF was helpful in the reduction of days on inhaled oxygen and tracheal intubation in preterm SIRS infants with hypercytokinemia. Further prospective randomized studies are warranted.
- Subjects
BRONCHOPULMONARY dysplasia; SEPSIS; NEONATAL necrotizing enterocolitis; POLYMYXIN B; SYSTEMIC inflammatory response syndrome; TRACHEOMALACIA; ALVEOLAR process; ANALYSIS of variance; BIRTH weight; BLOOD coagulation disorders; CYTOKINES; DEMOGRAPHY; FISHER exact test; HEMOPERFUSION; PREMATURE infants; INTERLEUKINS; OXYGEN; PEDIATRICS; RETROLENTAL fibroplasia; STATISTICS; SURFACE active agents; DATA analysis; CONTROL groups; RETROSPECTIVE studies; DESCRIPTIVE statistics; MANN Whitney U Test; HEMODIAFILTRATION; DIAGNOSIS; THERAPEUTICS
- Publication
Pediatrics International, 2016, Vol 58, Issue 11, p1176
- ISSN
1328-8067
- Publication type
Article
- DOI
10.1111/ped.13006