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Am J Perinatol 2020; 37(09): 962-969
DOI: 10.1055/s-0039-1692184
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Taylor Sawyer
1   Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
,
Zeenia Billimoria
1   Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
,
Sarah Handley
1   Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
,
Kendra Smith
1   Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
,
Larissa Yalon
2   Extracorporeal Life Support Services, Seattle Children's Hospital, Seattle, Washington
,
Thomas V. Brogan
3   Division of Pediatric Critical Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
,
Robert DiGeronimo
1   Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
› Author Affiliations
Further Information

Publication History

26 March 2019

26 March 2019

Publication Date:
08 June 2019 (online)

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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.

Keywords

therapeutic plasma exchange - neonate - septic shock - sepsis - viral sepsis - extracorporeal life support - adenovirus - group B streptococcal sepsis
 

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