Murray et al1 recently reported on the use of recombinant human granulocyte colony-stimulating factor (rhG-CSF) for neutropenia due to congenital neonatal sepsis in a preterm infant. We describe a premature infant in whom neutropenia due to Klebsiella sepsis developed at 8 days of age and who received rhG-CSF, resulting in the rapid resolution of neutropenia but with a different onset of action, magnitude, and duration of response.
A 1446-g male infant was born at 32 weeks' gestation to a 28-year-old insulin-dependent primigravida. The patient's initial postnatal course was remarkable for mild respiratory distress, transient hypoglycemia, indirect hyperbilirubinemia, and a 7-day course of intravenous ampicillin sodium for presumed group B Streptococcus sepsis (a positive urine latex agglutination test and negative blood culture). At 8 days of age, necrotizing enterocolitis developed and his white blood cell and absolute neutrophil counts fell over 24 hours from 7.0 and 4.48× 10