The effect of exchange transfusion on mortality in neonatal sepsis: a meta-analysis

Mathias, Sitarah; Balachander, Bharathi; Bosco, Ashish; Britto, Carl; Rao, Suman

doi:10.1007/s00431-021-04194-w

Cited by 4 publications

(1 citation statement)

References 37 publications

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“…Moreover, they do not have mortality rate as their primary objective. Recently, Mathias et al conducted a meta-analysis in order to evaluate the effect of ET on mortality in neonatal sepsis [ 58 ]. The authors demonstrated a mortality benefit (relative risk: 0.72, p = 0.01) and a significant increase in immunological parameters (IG and complement levels) ( p = 0.02) and neutrophil counts ( p = 0.03) compared with controls in septic neonates who underwent ET.…”

Section: Efficacy Of Exchange Transfusion In Managing Neonatal Sepsismentioning

confidence: 99%

Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons

Iijima

2022

JCM

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Neonatal sepsis remains a leading cause of morbidity and mortality worldwide. It is widely considered that exchange transfusion (ET) as an adjunctive treatment for neonatal sepsis has the ability to reduce mortality. This review summarizes the current knowledge regarding the efficacy of ET for neonatal sepsis. In neonatal sepsis, immune responses such as proinflammatory and anti-inflammatory cytokines play an important role in pathogenesis and can lead to septic shock, multiple organ failure, and death. Between the 1970s and 1990s several authors reported that ET was effective in the treatment of neonatal sepsis with sclerema. ET removes bacterial toxins and inflammatory cytokines from the blood by replacing it with fresh and immunologically abundant blood, thereby leading to improvement in tissue perfusion and oxygenation. Moreover, ET with fresh whole blood increases neutrophil count and immunoglobulin levels as well as enhancing neutrophil function. However, there is a lack of clear evidence for the clinical efficacy of ET. In addition, adverse events associated with ET have been reported. Although most complications are transient, ET can lead to life-threatening complications. Therefore, ET can be considered a last resort treatment to rescue neonates with severe sepsis with sclerema and disseminated intravascular coagulation.

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Section: Efficacy Of Exchange Transfusion In Managing Neonatal Sepsismentioning

confidence: 99%

Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons

Iijima

2022

JCM

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Current Resources for Evidence-Based Practice, May 2022

Bovbjerg¹

2022

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Adjuvant therapy in neonatal sepsis to prevent mortality - A systematic review and network meta-analysis

Abiramalatha

Ramaswamy

Bandyopadhyay

et al. 2022

NPM

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BACKGROUND: Despite appropriate antibiotic therapy, the risk of mortality in neonatal sepsis still remains high. We conducted a systematic review to comprehensively evaluate different adjuvant therapies in neonatal sepsis in a network meta-analysis. METHODS: We included randomized controlled trials (RCTs) and quasi-RCTs that evaluated adjuvant therapies in neonatal sepsis. Neonates of all gestational and postnatal ages, who were diagnosed with sepsis based on blood culture or sepsis screen were included. We searched MEDLINE, CENTRAL, EMBASE and CINAHL until 12th April 2021 and reference lists. Data extraction and risk of bias assessment were performed in duplicate. A network meta-analysis with bayesian random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. RESULTS: We included 45 studies involving 6,566 neonates. Moderate CoE showed IVIG [Relative Risk (RR); 95% Credible Interval (CrI): 1.00; (0.67–1.53)] as an adjunctive therapy probably does not reduce all-cause mortality before discharge, compared to standard care. Melatonin [0.12 (0–0.08)] and granulocyte transfusion [0.39 (0.19–0.76)] may reduce mortality before discharge, but CoE is very low. The evidence is also very uncertain regarding other adjunctive therapies to reduce mortality before discharge. Pentoxifylline may decrease the duration of hospital stay [Mean difference; 95% CrI: –7.48 days (–14.50–0.37)], but CoE is very low. CONCLUSION: Given the biological plausibility for possible efficacy of these adjuvant therapies and that the CoE from the available trials is very low to low except for IVIG, we need large adequately powered RCTs to evaluate these therapies in sepsis in neonates.

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The effect of exchange transfusion on mortality in neonatal sepsis: a meta-analysis

Cited by 4 publications

References 37 publications

Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons

Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons

Current Resources for Evidence-Based Practice, May 2022

Adjuvant therapy in neonatal sepsis to prevent mortality - A systematic review and network meta-analysis

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