What is the role of immunotherapy in the treatment of neonatal infections due to chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

Newborns are vulnerable to infection because of an immature immune system. [222] Factors that render neonates susceptible to bacterial infections include reduced numbers and/or function of macrophages and dendritic cells in peripheral tissues (eg, lung); lower numbers of neutrophils in the bone marrow storage pool [188] ; decreased immunoglobulin G (IgG) and complement levels, especially in prematurely born infants; an inability to respond to bacterial carbohydrate antigens; an increased percentage of T cells bearing naïve cell surfaces and correspondingly underdeveloped functional behaviors related to foreign antigens; and anatomic and biochemical immaturity of skin and mucosal barriers (eg, lung and gut epithelia) as they relate to local host defenses.

Emerging treatments, such as the use of intravenous immunoglobulins and hematopoietic growth factors, may correct deficiencies of the neonatal immune system. [223]  However, the use of immunotherapy still requires more investigation before these treatments become a standard of care. [224] Specifically, the routine use of intravenous immunoglobulins to treat neonatal sepsis is not established, [225] and the use of granulocyte colony stimulating factor (G-CSF) and granulocyte/macrophage colony stimulating factor (GM-CSF) may have a limited role in managing infected preterm infants with neutropenia. [226] The mainstays of current neonatal intensive care for bacterial sepsis in neonates are prompt recognition of bacterial infection, antimicrobial therapy, and supportive care. (In this review, supportive care is only briefly discussed below. See the Medscape Drugs and Disease article Neonatal Sepsis for a more in-depth care of these critically-ill neonates.)


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