Polymyxin B‐immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome. Issue 11 (24th July 2016)

• Record Type: Journal Article
• Authors: Maede, Yoshinobu; Ibara, Satoshi; Tokuhisa, Takuya; Ishihara, Chie; Hirakawa, Eiji; Matsui, Takako; Takahashi, Daijiro; Machigashira, Seiro; Minakami, Hisanori
• Is Part Of: Pediatrics international. Volume 58:Issue 11(2016)
• Page Start: 1176
• Page End: 1182
• Publication Date: 2016-07-24
• Subjects: coagulation–fibrinolysis -- necrotizing enterocolitis -- retinopathy of prematurity -- systemic inflammatory response syndrome -- tracheomalacia; Pediatrics -- Periodicals; 618.92
• DOI: 10.1111/ped.13006
• Languages: English
• ISSNs: 1328-8067

Abstract

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.