Clinical Effects and Outcomes After Polymyxin B–Immobilized Fiber Column Direct Hemoperfusion Treatment for Septic Shock in Preterm Neonates*

Abstract

Objectives: To compare the effectiveness and mortality of early-onset sepsis or late-onset sepsis treatments with polymyxin B–immobilized fiber column direct hemoperfusion in terms of effectiveness and mortality in preterm infants with septic shock. Design: Retrospective cohort study. Setting: Neonatal ICU within a tertiary care hospital. Patients: Of 1,115 patients, 49 had blood culture–proven sepsis between January 2013 and December 2018; six and five patients with septic shock had undergone polymyxin B–immobilized fiber column direct hemoperfusion treatment for early-onset sepsis (early-onset sepsis group) and late-onset sepsis (late-onset sepsis group), respectively. Interventions: None. Measurements and Main Results: Baseline demographic characteristics of both groups were similar. The time from decision to treatment induction was significantly shorter in the early-onset sepsis group than that in the late-onset sepsis group (p = 0.008). The mortality rate after 28 days of treatment and the hospital mortality were significantly lower in the early-onset sepsis group than in the late-onset sepsis group (p = 0.026 and 0.015, respectively). The Pao 2/Fio 2 ratio was significantly higher in the early-onset sepsis group than in the late-onset sepsis group at the end of the treatment (p = 0.035). In addition, median arterial-to-alveolar oxygen tension ratio significantly improved from 0.19 to 0.55, and median blood pressure also significantly improved from 32.5 to 40.0 mm Hg after the treatment in the early-onset sepsis group. Interleukin-6 levels significantly decreased after treatment in the early-onset sepsis group (p = 0.037). The Pediatric Risk of Mortality III score was similar between the early-onset sepsis and late-onset sepsis groups before and after the treatment. Intraventricular hemorrhage events occurred in both groups, but with no significant differences (p = 0.175). Conclusions: Polymyxin B–immobilized fiber column direct hemoperfusion treatment for preterm infants with septic shock due to early-onset sepsis is associated with earlier hemodynamic and respiratory status improvements and with lower mortality than that due to late-onset sepsis. Early neonatal septic shock detection and polymyxin B–immobilized fiber column direct hemoperfusion induction may improve the prognosis of affected infants.

Suggestions and tips regarding polymyxin B-immobilized fiber column direct hemoperfusion of neonates with sepsis

“…The authors concluded that PMX-DHP could be used as an adjunctive treatment for selected neonates with Gram-negative bacterial septic shock. Although I partly agree with the authors, my colleagues and I recently reported that the effectiveness of PMX-DHP was limited in neonates with septic shock due to late-onset sepsis (onset > 72 hours after birth) [2]. I wish to comment on the use of PMX-DHP for neonatal septic shock and provide suggestions based on our experiences.…”

Selective Polymyxin Hemoperfusion in Complex Therapy of Sepsis in Children after Cardiac Surgery

“…We observed how selective PMX hemoperfusion resulted in hemodynamic parameter improvements that were associated with a tendency toward a mean arterial pressure increase with an unchanged need for inotropic support. Many authors describe a similar positive effect of selective hemoperfusion on the circulatory system in patients with sepsis and septic shock [13, 15, 29, 30].…”

“…"TORAY" in Japan developed optimal-sized cartridges for children weighing 10-30 kg, namely, Toraymyxin-PMX-05R, and for newborns, namely, Toraymyxin-PMX-01R. Single cases of hemoperfusion with such cartridges with PMX B-immobilized fibers have been reported in the literature for sepsis treatment in children [13][14][15][16][17] and in experimental studies [18,19].…”

Unsatisfactory Short-Term Neurodevelopmental Outcomes of Preterm Infants Who Received Polymyxin B-Immobilized Fiber Column-Direct Hemoperfusion for Septic Shock

“…Of all hospitalized infants, 49 had sepsis confirmed via blood culture. Among them, 11 received PMX-DHP for early-or late-onset septic shock according to a procedure in a previous study (Nishizaki et al 2020a). The inclusion criteria for PMX-DHP were as follows: (1) The first diagnosis was sepsis; (2) Met the presence of systemic inflammatory response syndrome (SIRS) based on the Goldstein et al (2005) criteria; and (3) Required catecholamine (> 10 μg/kg/min) and/or serum interleukin (IL)-6 > 500 pg/mL measured using a semi quantitative measurement kit (STICKELISA ® and RAY-FAST ® ; Toray, Tokyo, Japan).…”

“…Recently, endotoxin and mediator removal using a polymyxin B-immobilized fiber column for direct hemoperfusion (PMX-DHP) has been utilized for severe septic shock even in neonates (Nishizaki et al 2016). We have previously reported the effect of PMX-DHP on septic shock in preterm infants (Nishizaki et al 2020a). Our results showed that PMX-DHP for early-onset sepsis (sepsis occurring ≤ 72 h after birth) had a significantly lower mortality rate than that for late-onset sepsis (occurring > 72 h after birth).…”