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A randomised trial of granulocyte-macrophage colony-stimulating factor for neonatal sepsis : outcomes at 2 years
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Marlow, Neil, Morris, T., Brocklehurst, P., Carr, R., Cowan, F. M., Patel, N., Petrou, Stavros, Redshaw, M. E., Modi, N. and Dore, C. (2013) A randomised trial of granulocyte-macrophage colony-stimulating factor for neonatal sepsis : outcomes at 2 years. Archives of Disease in Childhood - Fetal and Neonatal Edition, Volume 98 (Number 1). F46-F53. doi:10.1136/fetalneonatal-2011-301470 ISSN 1359-2998.
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WRAP_Petrou_Arch Dis Child Fetal Neonatal Ed-2013-Marlow-F46-53.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. Download (354Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/fetalneonatal-2011-30147...
Abstract
Objective The authors performed a randomised trial in very preterm small-for-gestational age (SGA) babies to determine if prophylaxis with granulocyte-macrophage colony-stimulating factor (GM-CSF) improves outcomes (the PROGRAMS trial). Despite increased neutrophil counts following GM-CSF, the authors reported no significant difference in neonatal sepsis-free survival.
Patients and methods 280 babies born <31 weeks of gestation and SGA were entered into the trial. Outcome was determined at 2 years to determine neurodevelopmental and general health outcomes, including economic costs.
Results The authors found no significant differences in health outcomes or health and social care costs between the trial groups. In the GM-CSF arm, 87 of 134 (65%) babies survived to 2 years without severe disability compared with 87 of 131 (66%) controls (RR: 1·0, 95% CI 0·8 to 1·2). Marginally, more children receiving GM-CSF were reported to have cough (RR 1·7, 95% CI 1·1 to 2·6) and had signs of chronic respiratory disease (Harrison's sulcus; RR 2·0, 95% CI 1·0 to 3·9) though this was not reflected in bronchodilator use or need for hospitalisation for respiratory disease. Overall, the rate of neurologic abnormality (7%–9%) was similar but mean overall developmental scores were lower than expected for gestational age.
Conclusions The administration of GM-CSF to very preterm SGA babies is not associated with improved or more adverse outcomes at 2 years of age. The apparent excess of developmental impairment in the entire PROGRAMS cohort, without corresponding increase in neurological abnormality, may represent diffuse brain injury attributable to intrauterine growth restriction.
Item Type: | Journal Article | ||||
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Subjects: | R Medicine > R Medicine (General) | ||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Archives of Disease in Childhood - Fetal and Neonatal Edition | ||||
Publisher: | B M J Group | ||||
ISSN: | 1359-2998 | ||||
Official Date: | 2013 | ||||
Dates: |
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Volume: | Volume 98 | ||||
Number: | Number 1 | ||||
Page Range: | F46-F53 | ||||
DOI: | 10.1136/fetalneonatal-2011-301470 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Open Access (Creative Commons) | ||||
Date of first compliant deposit: | 22 December 2015 | ||||
Date of first compliant Open Access: | 22 December 2015 |
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