Recombinant haemopoietic growth factors in the newborn — will they be useful?

In vivo, realisation of the physiological reserve capacity of haemopoiesis depends on stimulation by cytokines, growth factors produced by autologous blood mononuclear cells. These cytokines include erythropoietin, granulocyte/macrophage colony stimulating factors, and thrombopoietin. In preterm infants, inadequate haemopoietic growth factor production limits haemopoiesis in its response to demands for extra blood cell production in stress situations. Haemopoiesis may also be inhibited by inflammatory disease and by nutritional deficiencies. In infants in intensive care, losses of blood, which contain haemopoietic stem cells and other progenitors, may also impair blood cell production. Recombinant haemopoietic growth factors promise to prevent or correct in part, this haemopoietic inadequacy. Verification of their therapeutic roles depends on further improvements in management of the preterm infant. These improvements include the optimisation of nutritional support and, especially, in terms of the endowment of blood from the placenta at birth, which strongly influences clinical outcome.