Abstract
Bone marrow neutrophil depletion (BMND) has been suggested as a criterion for white blood cell (WBC) transfusions in neonatal sepsis. To determine the incidence of BMND in neonates presenting with signs consistent with sepsis and the relationship of BMND to clinical outcome, bone marrow aspirates were done in 13 neonates (1010-3845 gms) with clinical sepsis and neutropenia. Neutropenia was defined as an absolute peripheral neutrophil count < 1500/mm2 on 2 occasions ≥ 3 hrs apart and BMND was defined as < 7% segs, bands and metamyelocytes per 100 nucleated cells. If BMND was present, patients were randomized to standard treatment (ST) or to ST plus transfusion of irradiated, fresh buffy coat concentrate. 13 of 14 aspirates were interpretable and no complications occurred. Results are as follows:
These data show: 1) neonates with suspected sepsis and neutropenia had a 23% (3/13) incidence of BMND, 2) if BMND was not present 90% (9/10) of clinically septic, neutropenic neonates survived. Since the incidence of BMND is low and the risks and benefits of WBC transfusions are unknown, bone marrow examinations should be done to properly identify high risk neonates for inclusion in controlled studies of WBC transfusions.
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Wheeler, J., Abramson, J., Boyle, R. et al. BONE MARROW EXAMINATIONS IN SEPTIC NEUTROPENIC NEONATES. Pediatr Res 18 (Suppl 4), 355 (1984). https://doi.org/10.1203/00006450-198404001-01573
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DOI: https://doi.org/10.1203/00006450-198404001-01573