Preterm bebeklerin nozokomiyal sepsisinde pentoksifilin tedavisi

Year 2019, Volume: 44 Issue: 4, 1412 - 1417, 29.12.2019

Mustafa Kurthan Mert , Ferda Özlü Hacer Yapıcıoğlu Yıldızdaş , Mehmet Satar

https://doi.org/10.17826/cumj.605903

Abstract

Amaç: Nozokomiyal sepsis, hastane kaynaklı kazanılmış infeksiyonlar arasında en sık olanıdır. Uygun antibiyotik tedavisine rağmen sepsisin mortalitesi ve morbiditesi hala yüksektir. Bu nedenle diğer tedavi yöntemleri hala aranmaktadır. Yenidoğan yoğun bakım ünitesinde yatan prematüre bebeklerde pentoksifilinin neonatal nozokomiyal sepsisin prognozu üzerine etkisini değerlendirmeyi amaçladık.

Gereç ve Yöntem: Bu çalışmaya nozokomiyal sepsis tanısı konan 80 yenidoğan dahil edildi. Bunların 40'ı antibiyotiklere ek olarak pentoksifilin tedavisi alırken, diğer 40'ı almadı ve kontrol grubunu oluşturdu. Gebelik yaşı, doğum ağırlığı, 1. ve 5. dakikadaki Apgar skorları, doğum şekli, cinsiyeti, surfaktan tedavisi, ventilatör tedavisi ve erken başlangıçlı sepsis varlığı vaka grubuyla kontrol arasında karşılaştırıldı.

Bulgular: Gruplar arasında tanı anında gebelik haftası, cinsiyet, doğum ağırlığı, mortalite, nötrofil sayısı veya prokalsitonin düzeylerine göre istatistiksel bir fark yoktu. Ayrıca, hastanede kalış süresi, bronkopulmonerdisplazi veya nekrotizan enterokolit gelişmesine göre de gruplar arasında istatistiksel bir fark yoktu.

Sonuç: Pentoksifilin, preterm nozokomiyal sepsisin mortalitesi ve morbiditesi üzerinde önemli bir etkiye sahip değildir.

Keywords

Pentosifilin, premature, sepsis

Supporting Institution

Destekleyen kurum yoktur.

Pentoxyfilline treatment in nosocomial sepsis of preterm infants

Abstract

Purpose: Nosocomial sepsis is the most common acquired infection. Despite appropriate antibiotic treatment, mortality and morbidity of sepsis are still high. We aimed to evaluate the effect of pentoxifylline on prognosis of neonatal nosocomial sepsis in premature infants hospitalized in the neonatal intensive care unit.

Materials and Methods: Eighty newborns diagnosed as nosocomial sepsis were included in this study. Forty of them received pentoxifylline treatment in addition to antibiotics, while the other 40 did not receive additional treatment and formed the control group. The sex, mode of delivery, gestational age, birth weight, Apgar scores at the 1st and 5th minutes, surfactant therapy, ventilator therapy and presence of early onset sepsis were compared between the case group and the control.

Results: There was no statistical difference between groups according to gestational week, gender, birth weight, mortality, neutrophil count or procalcitonin level at the time of diagnosis. Also, there was not any statistical difference according to duration of hospitalization between the bronchopulmonary dysplasia or necrotizing enterocolitis groups.

Conclusion: Pentoxifylline has no significant impact on mortality and morbidity of preterm nosocomial sepsis.

Keywords

pentoxifylline, premature, sepsis

References

• 1. Carey AJ,Saiman L,Polin RA. Hospital-aquired infections in the NICU: epidemiology for the new millennium. Clin Perinatol. 2008; 35: 223-49.2. Edwards MS, Baker CJ. Sepsis in the newborn. In: Gershon AA, Hotez PJ, Katz SL (eds): Krugman's Infectious Diseases of Children. 11th ed. Philadelphia: Mosby. 2004,p. 545-61.3. Harrison GJ. Infections of the fetus and newborn. In: Feigin RD, Cherry JD, Demmler G, Kaplan S, Steinbach W, Hotez P (eds). Textbook of Pediatric Infectious Diseases. 7th ed. Vol. 1. Philadelphia: Saunders. 2014,p. 876-901.4. Ferrieri P, Wallen LD. Neonatal Bacterial Sepsis. In: Gleason CA, Devaskar SU(eds). Avery's Diseases of the Newborn. 9th ed. Philadelphia: Elsevier Inc. 2012,p. 538-50.5. Bajcetic M, Spasic S, Spasojevic I. Redox therapy in neonatal sepsis: reasons, targets, strategy, and agents. Shock. 2014; 42: 179–84.6. Damas P, Canivet JL, Groot DD, Vrindts Y, Albert A, Franchimond P, Lamy M. Sepsis and serum cytokine concentrations. Crit Care Med. 1997; 25: 405-12.7. Casey LC. Immunologic response to infection and its role in septic shock. Crit Care Clin. 2000; 16: 193-213.8. Ali W, Ahmed P, Bhat AM, Mushtaq S. Pentoxifylline in treatment of sepsis of premature neonates. JK Pract. 2006; 13: 204-079. Harris E, Schulzke SM, Patole SK. Pentoxifylline in preterm neonates: a systematic review. Paediatr Drugs. 2010; 12:301–11.10. Lauterbach R, Zembala M. Pentoxifylline reduces plasma tumour necrosis factor-alpha concentration in premature infants with sepsis. Eur J Pediatr. 1996; 155: 404–09.11. Lauterbach R, Pawlik D, Kowalczyk D, Ksycinski W, Helwich E, Zembala M. Effect of the immunomodulating agent, pentoxifylline, in the treatment of sepsis in prematurely delivered infants: a placebo-controlled, double-blind trial. Crit Care Med. 1999; 27: 807-14.12. Kuzniewicz MW, Puopolo KM, Fischer A, Walsh EM, Li S, Newman TB et al. A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis. JAMA Pediatr. 2017; 171: 365-71.13. Akdag A, Dilmen U, Haque K, Dilli D, Erdeve Ö, Gokmen T. Role of Pentoxifylline and/or IgM-Enriched Intravenous Immunoglobulin in the Management of Neonatal Sepsis. Am J Perinatol. 2014; 31: 905–1214. Yapicioglu H, Satar M, Ozcan K, Narli N, Özlü F, Sertdemir Y et al. A 6-year prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey. J Paediatr Child Health. 2010; 46: 337-42.15. Walsh MC, Kliegman RM. Necrotizing enterocolitis: Treatment based on staging criteria. Pediatr Clin North Am. 1986; 33: 179-201.16. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001; 163: 1723-9.17. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldman DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005; 365: 1175–88.18. Kawagoe JY, Segre CAM, Pereira CR, Cardosa MF, Silva CV, Fukushima JT. Risk factors for nosocomial infections in critically ill newborns: A 5-year prospective cohort study. Am J Infect Control. 2001; 29: 109–14.19. Casey LC, Balk RA, Bone RC. Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med. 1993; 119: 771-8. 20. Ng PC, Li K, Wong RP, Chui K, Wong E, Li G et al. Proinflammatory and anti-inflammatory cytokine responses in preterm infants with systemic infections. Arch Dis Child Fetal Neonatal Ed. 2003; 88: 209–13. 21. Harris MC, D’Angio CT, Gallagher PR, Kaufman D, Evans J, Kilpatrick L. Cytokine elaboration in critically ill infants with bacterial sepsis, necrotizing enterocolitis, or sepsis syndrome: correlation with clinical parameters of inflammation and mortality. J Pediatr. 2005; 147: 462–8. 22. Mandi Y, Farkas G, Ocsovszky I, Nagy Z. Inhibition of tumor necrosis factor production and ICAM-1 expression by pentoxifylline: beneficial effects in sepsis syndrome. Res Exp Med. 1995; 195: 297-307. 23. Selim K, Hüseyin C, İbrahim KH, Hasan BU, Kazim U, Hüseyin K. Effect of Pentoxifylline on Tumor Necrosis Factor-Alpha and Interleukin-6 Levels in Neonatal Sepsis. Med J Malaysia. 2004; 59: 391-4.24. Shabaan AE, Nasef N, Shouman B, Nour I, Mesbah A, Abdel-Hady H. Pentoxifylline therapy for late sepsis in preterm Infants, A randomized control trial. The Pediatric Infec Disease J. 2015; 34: 145-8.25. Pammi M, Haque KN. Pentoxifylline for treatment of sepsis and necrotizing enterocolitis in neonates. Cochr Database Syst Rev. 2015;9 (3):CD004205.