G-CSF and GM-CSF for treating or preventing neonatal infections

Infants born before 32 weeks and infants that are small for their gestational age are at high risk of developing infections while in hospital. These infections can cause death, disability (including cerebral palsy) as a result of damage to nervous tissue as well as contributing to chronic lung disease. Infection-related deaths have remained constant for two decades and antibiotic resistance is increasing, emphasising the need for new ways to prevent infection.

The haemopoietic colony stimulating factors (CSFs), granulocyte-macrophage colony stimulating factor (GM-CSF) and granulocyte colony stimulating factor (G-CSF) are naturally occurring substances (cytokines) that can increase circulating white blood cells (neutrophils) and their ability to destroy bacteria. Common minor side effects are low grade fever and skeletal pain. The review authors identified seven treatment studies of 257 premature infants with suspected systemic bacterial infection. Adding G-CSF or GM-CSF to antibiotic therapy did not improve survival, overall. It may be, however, that infants who had clinically low neutrophils at the start of treatment did show some reduction in number of deaths by day 14 (taken from three studies). In three studies in which 359 low birthweight or premature neonates were treated preventatively (prophylaxis) no reduction in deaths was evident in those neonates receiving GM-CSF. GM-CSF was well tolerated with no adverse reactions in these small studies.