Intravenous pentoxifylline is well tolerated in critically ill preterm infants with sepsis or necrotizing enterocolitis

• Published in: European journal of pediatrics 2020-08, Vol.179 (8), p.1325-1330
• Main Authors: Schüller, Simone S, Kempf, Kristina, Unterasinger, Lukas, Strunk, Tobias, Berger, Angelika
• Format: Article
• Language: English
• Subjects: Birth weight; Critical Illness; Drug Administration Schedule; Enterocolitis; Enterocolitis, Necrotizing - drug therapy; Female; Gastrointestinal diseases; Gestational age; Hematology; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - drug therapy; Infants; Inflammation; Infusions, Intravenous; Intensive Care, Neonatal - methods; Intravenous administration; Male; Medicine; Medicine & Public Health; Necrosis; Necrotizing enterocolitis; Neonatal Sepsis - drug therapy; Neonates; Newborn babies; Pediatrics; Pentoxifylline - administration & dosage; Pentoxifylline - therapeutic use; Phosphodiesterase Inhibitors - administration & dosage; Phosphodiesterase Inhibitors - therapeutic use; Premature babies; Respiratory therapy; Retrospective Studies; Sepsis; Short Communication; Side effects; Treatment Outcome
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-020-03612-9

Pentoxifylline (PTX) is a candidate adjuvant medication for the treatment of sepsis and necrotizing enterocolitis in preterm infants. There is only limited data on safety and compatibility with other commonly used intravenous medications. This retrospective single-center study of 198 preterm infants (September 2012–September 2018) was performed at a level IV neonatal intensive care unit. Electronic data of all preterm infants who received pentoxifylline for sepsis or necrotizing were extracted from routine databases. We analyzed a total of 1081 PTX treatment days from 217 treatment episodes in 198 preterm infants (mean gestational age 27 weeks; mean birth weight 1060 g). At a mean daily dose of 28 mg/kg, no clinically relevant side effects were observed. PTX therapy was not associated with clinically significant changes of blood biochemistry and hematology parameters. Concomitant infusion of PTX with other common NICU medications was well tolerated, and there was no evidence of incompatibility. Conclusion : Intravenous PTX is compatible with standard NICU drugs and well tolerated in critically ill preterm infants. What is Know: • Currently, there are no evidence-based adjuvant medications available that target the harmful inflammatory host response in neonatal sepsis or necrotizing enterocolitis. • Pentoxifylline (PTX) is a candidate adjuvant medication for the treatment of sepsis and necrotizing enterocolitis in preterm infants; however, safety data are rare and PTX is currently used off-label. What is New: • Here we report on our experience in the pragmatic routine use of PTX as adjuvant therapy in 198 preterm infants with sepsis or NEC. • Concomitant infusion of PTX with other common NICU medications was well tolerated, and there was no evidence of incompatibility. No clinically relevant side effects were observed.