Therapeutic Plasma Exchange in Neonatal Septic Shock: A Retrospective Cohort Study

Abstract

Objective This study aimed to examine the use of therapeutic plasma exchange (TPE) as adjunctive therapy in neonatal septic shock. Study Design This retrospective cohort study was performed on a convenience sample of neonates in a quaternary children's hospital between January 2018 and February 2019. Results We identified three neonates with septic shock who received TPE. Two neonates had adenovirus sepsis, and one had group B streptococcal sepsis. All neonates were on extracorporeal life support (ECLS) when TPE was started. The median duration of TPE was 6 days (interquartile range [IQR]: 3–15), with a median of four cycles (IQR: 3–5). Lactate levels decreased significantly after TPE (median before TPE: 5.4 mmol/L [IQR: 2.4–6.1] vs. median after TPE: 1.2 mmol/L [IQR: 1.0–5.8]; p < 0.001). Platelet levels did not change (median before TPE: 73,000/mm3 [IQR: 49,000–100,000] vs. median after TPE: 80,000/mm3 (IQR: 62,000–108,000); p = 0.2). Organ failure indices improved after TPE in two of the three neonates. Hypocalcemia was seen in all cases despite prophylactic calcium infusions. One neonate died, and two survived to ICU discharge. Conclusion TPE can be safely performed in neonates with septic shock. TPE may have a role as an adjunctive therapy in neonates with septic shock requiring ECLS.

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

“…Evidence suggests that PE can reduce mortality in adult patients with sepsis and septic shock [ 64 ]. Several studies have reported that PE in neonates results in improvement of multiple organ failure caused by septicemia [ 65 ]. Recently, as the new technology of extracorporeal PE hemoabsorption devices for cytokine reduction (such as Toraymyxin (Toray, Tokyo, Japan) [ 66 ] and CytoSorb (CytoSorbents Europe, GmbH, Berlin, Germany) [ 67 , 68 ]) has been introduced, contributing to the achievement of rapid hemodynamic stabilization in neonatal and pediatric patients with refractory septic shock.…”