Current and emerging treatments for neonatal sepsis

ABSTRACT

Introduction

Mortality due to sepsis is still prevalent, peaking at extreme ages of life including infancy. Despite many efforts, the peculiarity of the infant immune system has limited further advances in its treatment. Indeed, neonates experience a dramatic physiological transition from immune tolerance to the maternal antigens to functional maturity. Such a transition is extremely dynamic, as is the pathophysiology of infant sepsis, which is dependent on many infant, maternal, and environmental factors.

Areas covered

In this review, the authors critically update and summarize the current paradigm of immunomodulation in infant sepsis. They confirm how exogenous stimulation of the immune system through intravenous immunoglobulin, colony stimulating factors, and granulocyte transfusion have failed to impact on the prognosis of infant sepsis. They also strongly support the beneficial effects of supplementation/replacement therapies with products naturally contained within maternal milk as well as antioxidant compounds.

Expert opinion

Breastfeeding is beneficial against sepsis. Knowledge of the neonatal immune system is indeed too limited to effectively strengthen immune response by exogenous interventions, especially in preterm and low-birth-weight infants. Awareness of this limitation should pave the way for future studies (e.g. gender- and omics-based) aimed at better characterizing the infant immune system and promoting a more tailored approach.

KEYWORDS:

• Infant sepsis
• immunomodulation
• lactoferrin
• zinc
• probiotics

Article highlights

• Neonatal sepsis is an extremely heterogeneous and dynamic condition.

• Both pathogen and host factors, which in turn depend on gestational age, maternal and environmental factors, contribute to neonatal sepsis.

• Dysbiotic gut microbiota is associated with intestinal inflammation and increased risk of necrotizing enterocolitis.

• Breastfeeding still remains the cornerstone for the prevention and treatment of neonatal sepsis.

• Gender influence on immune function has a critical role in determining the outcome of neonatal sepsis.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.