Suggestions and tips regarding polymyxin B-immobilized fiber column direct hemoperfusion of neonates with sepsis

I read with great interest the case report entitled, “A successful application of adult polymyxin B-immobilized fiber column hemoperfusion to a neonate with septic shock” by Kim et al [1]. In this case, a female neonate was born at a gestational age of 38 weeks with a birth weight of 3.0 kg. She developed late-onset septic shock caused by a carbapenem-resistant Acinetobacter baumannii infection and was treated with extracorporeal membrane oxygenation (ECMO) and adult polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP). These interventions yielded significant short-term improvements in cardiopulmonary function. However, the patient died of multiorgan dysfunction syndrome two days after discontinuation of ECMO and PMX-DHP. The authors concluded that PMX-DHP could be used as an adjunctive treatment for selected neonates with Gram-negative bacterial septic shock. Although I partly agree with the authors, my colleagues and I recently reported that the effectiveness of PMX-DHP was limited in neonates with septic shock due to late-onset sepsis (onset > 72 hours after birth) [2]. I wish to comment on the use of PMX-DHP for neonatal septic shock and provide suggestions based on our experiences.