Emerging treatments
Pentoxifylline
Pentoxifylline is a methylxanthine derivative that inhibits erythrocyte phosphodiesterase and has anti-inflammatory properties. It also lowers blood viscosity and is thought to improve microcirculation and tissue perfusion.[152] Pentoxifylline may reduce mortality in term and preterm neonates with sepsis and necrotising enterocolitis, as well as chronic lung disease and hypoxic ischaemic encephalopathy. A Cochrane review found a reduction in all-cause mortality with pentoxifylline, which was based on evidence from 6 low-quality randomised controlled trials involving a total of 416 neonates with sepsis.[153]
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There was no evidence of adverse effects. Other small trials have shown a reduction in the incidence of haemorrhage and fresh frozen plasma use, multiple organ dysfunction syndrome score, and length of hospital stay in neonates with sepsis.[154] Further research is required before pentoxifylline could be recommended for widespread routine clinical practice in the treatment of neonatal sepsis or necrotising enterocolitis.
Near-infrared spectroscopy
A non-invasive method of measuring venous oxygen saturations in specific organs (e.g., brain, kidneys, liver, bowel, muscle). In some units, it is considered a standard of care for haemodynamic monitoring, particularly for children and neonates undergoing cardiac surgery. There are several small studies in adults with sepsis demonstrating its utility in predicting low cardiac output.[155][156][157] It may be useful in neonates and small infants where invasive cardiac output monitoring is not possible.
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