ABSTRACT. Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) induces proliferation and differentiation of hematopoietic stem cells. Additionally, rhGM-CSF enhances the physiologic responses of adult polymorphonuclear leukocytes (PMN) especially with respect to oxidative metabolism and chemotaxis. Neonatal PMN are deficient in chemotaxis and have been demonstrated to have reduced oxidative responses in times of stress. We evaluated the priming effects of rhGM-CSF (1-100 pmol/L) on cord (neonatal) superoxide production and chemotaxis. Cord and adult PMN were incubated with 100 pmol/L rhGM-CSF (Amgen, 4 % lo7 U/ mg) for 0-120 rnin and stimulated with ~lform~l-1-methionyl-1-leucyl-phenylalanine. RhGM-CSF enhanced 02-production at all time periods with maximal priming at 60 min (147.97 f 11.14% p 5 0.006) with less, but significant enhancement at 120 rnin (116.53 f 7.92% p 5 0.05).Maximal adult PMN 02-release occurred at 120 min (190.02 f 8.71% p 5 0.003) and was more pronounced than cord PMN. RhGM-CSF (100 pmol/L x 30 rnin) incubation of cord PMN also primed for increased PMN 0 2 -release after zymosan-activated serum stimulation ( p 5 0.05) but not PMA (p = NS). Co-incubating cord PMNs with 100 pmol/L rhGM-CSF and a murine anti-human GM-CSF antibody (0-100 mcg/ml) resulted in 95% inhibition of the priming effect of rhGM-CSF enhancement of cord PMN 02-release. RhGM-CSF, primed cord PMN for enhanced chemotaxis during early incubation (5 min) with both N-formyl-1-methionyl-1-leucyl-phenylalanine M) and Escherichia coli filtrate (113.54 f 6.11% p 5 0.025 and 110.84 f 4.69% p 5 0.001), respectively, but not at 30-min or 60-min incubation. These studies suggest that rhGM-CSF similarly primes neonatal PMN like adult PMN for enhanced in vitro PMN oxidative responses and chemotaxis. (Pediatr Res 26: 395-399, 1989) Abbreviations PMN, polymorphonuclear leukocyte (bands + neutrophils) rhGM-CSF, recombinant human granulocyte-macrophage colony stimulating factor

OBJECTIVES Although epinephrine is used in the neonatal intensive care unit, few data exist on efficacy of doses <0.05 mcg/kg/min. This study evaluates the efficacy and safety of low-dose epinephrine continuous infusion at doses <0.05 mcg/kg/min in infants. METHODS Single-center, retrospective review of hypotensive infants from 2011–2018. Charts were reviewed for initial and maximum epinephrine doses, additional vasoactive agents, short-term efficacy, and adverse effects. The primary outcome was percentage of patients initiated on low-dose epinephrine whose dose did not require titration to ≥0.05 mcg/kg/min. RESULTS A total of 115 patients met study criteria with 131 distinct occurrences of low-dose epinephrine initiation. Most patients were unresponsive to other vasopressors at the time of epinephrine initiation. The median (IQR) starting dose of low-dose epinephrine was 0.01 (0.01–0.04) mcg/kg/min and median (IQR) maximum dose was 0.04 (0.02–0.08) mcg/kg/min. Fifty-five percent were responders. Patients in this cohort demonstrated significant improvement of blood pressure and urine output (p < 0.001) without adverse effects. CONCLUSIONS Low-dose epinephrine infusion may be considered as an alternative treatment to standard starting doses in hypotensive neonatal intensive care unit patients.

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We report on a former 27-week gestational age infant who was placed on the Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM) at 4 months post-menstrual age while receiving cefepime treatment for an Enterobacter cloacae bacteremia and persistent peritonitis secondary to an infected peritoneal dialysis catheter. Using therapeutic drug monitoring while assessing the clearance of cefepime on continuous renal replacement therapy (CRRT), we were able to successfully treat this patient's infection while also minimizing the risk of side effects from this medication. Current literature supports dosing in adult patients on all modalities of CRRT with effluent flow rates of 20 to 25 mL/kg/hr; however, pharmacokinetic data on cefepime dosing in pediatric CRRT are scant. This case report describes the successful dosing strategy used for this patient while on various rates of continuous veno-venous hemodialysis with CARPEDIEM. Therapeutic drug monitoring of cefepime should be considered in critically ill pediatric patients on CARPEDIEM receiving CRRT.