Granulocyte-macrophage colony-stimulating factor in the treatment of neonates with neutropenia and sepsis.

To evaluate the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) in improving neutrophil counts and survival of neutropenic septic neonates, the authors studied 8 neonates with gestational or postconceptional age at least 30 weeks; weight at least 1000 g; serious infection with concomitant neutropenia (absolute neutrophil count [ANC] < 3.0 x 10(9)/L) or leukopenia (white blood cell count < 5.0 x 10(9)/L) and anticipated survival at least 48 h. Patients received 5 micrograms/kg of GM-CSF intravenously for 5 consecutive days or until the ANC reached 20 x 10(9)/L. Clinical parameters and complete blood counts were monitored. Prestudy ANCs ranged from 0.05 to 2.7 x 10(9)/L. Four patients had positive blood cultures, 4 had necrotizing enterocolitis, and 1 was in septic shock. All patients had elevated C-reactive protein. All patients had resolution of neutropenia and survived the septic episodes. The use of GM-CSF in these patients merits further exploration.