Dose:  10 mcg/kg/dose Subcutaneously or IV

Frequency: Q Day (@ 1600-daily late)

Comments: Filgrastim is a human granulocyte colony stimulating factor (G-CSF) produced by recombinant DNA technology from E. coli bacteria. G-CSF is a glycoproteins that act on hematopoietic cells causing neutrophil progenitor proliferation, differentiation, and enhancement of end-cell functions like phagocytosis and antibody-mediated killing. The few studies using filgrastim in the newborn period have targeted infants who have neutropenia due to sepsis or maternal hypertension. Further comments on filgrastim.

Toxicity: Follow up at 2 years of 21 infants treated with G-CSF showed no adverse hematological, immunological, or developmental effects (Rosenthal. J Pediatr 1996; 128:135). G-CSF administration may cause a false positive HBsAg assay (Hom. Transfusion 1995; 35:30S). See adverse effects associated with filgrastim.

Preparation: Filgrastim (Neupogen) is available in a 300 mcg/ml  preservative-free vial. May be diluted using D5W. Human serum albumin must be added if the final concentration is < 15 mcg/ml to prevent adsorption to plastic materials. The pharmacy will prepare as a 30 mcg/ml concentration. Do not dilute with normal saline or dilute to a concentration < 5 mcg/ml. Refrigerate at 36^o to 46^o F, do not freeze. Prior to injection, allow to warm to room temperature. Use one dose per vial. Discard after single use or if at room temperature for > 24 hours. May be given IV as an infusion over 15 minutes or subcutaneously, but has greater efficacy if given subcutaneously. Pharmacy should send the dose in a MedSaver syringe.