Should granulocyte transfusion therapy for septic neutropenic neonates be resurrected?

Nearly half a century ago, granulocyte transfusions were trialed in critically ill, septic, neutropenic neonates and showed improved survival when used concurrently with antimicrobials. Benefits were particularly noteworthy for Gram-negative and fungal infections. The introduction of granulocyte colony-stimulating factor into clinical medicine in 1991 and inherent problems associated with granulocyte procurement for transfusion caused granulocyte transfusions to become nearly extinct for this patient population. Simultaneous technological and clinical management advancements have enabled the survival of younger neonates, who are at the highest risk for neutropenia and neonatal sepsis. These infants have well-documented developmental deficiencies in the number and functional capabilities of their neutrophils compared to older patients. A continued surge in antimicrobial resistance and an increasing number of Gram-negative infections have created an urgent need for clinicians to rethink old therapies and consider new ones. This review details the evolution of granulocyte transfusions and whether they should be resurrected in neonatal patients.