Immunomodulation to Prevent or Treat Neonatal Sepsis: Past, Present, and Future

Simone S. Schüller*, Boris W. Kramer, Eduardo Villamor, Andreas Spittler, Angelika Berger, Ofer Levy*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

33 Citations (Web of Science)

Abstract

Despite continued advances in neonatal medicine, sepsis remains a leading cause of death worldwide in neonatal intensive care units. The clinical presentation of sepsis in neonates varies markedly from that in older children and adults, and distinct acute inflammatory responses results in age-specific inflammatory and protective immune response to infection. This review first provides an overview of the neonatal immune system, then covers current mainstream, and experimental preventive and adjuvant therapies in neonatal sepsis. We also discuss how the distinct physiology of the perinatal period shapes early life immune responses and review strategies to reduce neonatal sepsis-related morbidity and mortality. A summary of studies that characterize immune ontogeny and neonatal sepsis is presented, followed by discussion of clinical trials assessing interventions such as breast milk, lactoferrin, probiotics, and pentoxifylline. Finally, we critically appraise future treatment options such as stem cell therapy, other antimicrobial protein and peptides, and targeting of pattern recognition receptors in an effort to prevent and/or treat sepsis in this highly vulnerable neonatal population.

Original languageEnglish
Article number199
Number of pages17
JournalFrontiers in pediatrics
Volume6
DOIs
Publication statusPublished - 19 Jul 2018

Keywords

  • neonatal sepsis
  • preterm infant
  • adjuvant sepsis therapy
  • immunomodulation
  • pentoxifylline
  • lactoferrin
  • probiotics
  • human milk
  • LATE-ONSET SEPSIS
  • MESENCHYMAL STEM-CELLS
  • RANDOMIZED-CONTROLLED-TRIAL
  • PLACEBO-CONTROLLED-TRIAL
  • BIRTH-WEIGHT INFANTS
  • BACTERICIDAL/PERMEABILITY-INCREASING PROTEIN
  • MONOCLONAL-ANTIBODY PAGIBAXIMAB
  • INTRAVENOUS IMMUNE GLOBULIN
  • ORAL ZINC SUPPLEMENTATION
  • EXTREMELY PRETERM INFANTS

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