Sick or septic newborns including premature infants

There is no role for G-CSF or granulocyte-macrophage colony-stimulating factor (GM-CSF) in treatment of sick or septic newborns; growth factors increase ANC, but not survival.

8. Alloimmune neutropenia of newborn. Administer antibiotics and G-CSF, 5 mcg/kg/day, even if neonate appears well.

9. Infants of preeclamptic mothers. G-CSF increases ANC but not survival in sick infants with neutropenia.

VI. Problem Case Diagnosis. The 1-day-old infant has neonatal autoimmune neutropenia. His mother, who has an autoimmune disease (lupus), has had chronic benign neutropenia for years without significant infections. Her ANC is typically 400-600/mm3.

VII. Teaching Pearl: Question. A newborn infant has omphalitis and neutropenia. What tests should be ordered to confirm the likely diagnosis?

VIII. Teaching Pearl: Answer. The infant should be tested for presence of ANAs. Parents' blood should be sent for WBC antigen determination (ie, NA1 and NA2). It is likely that this infant has alloimmune neutropenia of the newborn. The presence of antigens on paternal, but not maternal, WBCs clinches the diagnosis.

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