HEMOPERFUSION ON A COLUMN WITH IMMOBILIZED POLYMYXIN B IN CHILDREN AND NEWBORNS

Highlights

• In this analytical review, it is proposed to consider the hemoperfusion method using columns containing polymyxin B as one of the promising extracorporeal methods for the treatment of sepsis in children and newborns.
• Based on the currently available relevant data on the clinical use of polymyxin hemoperfusion and the results of scientific research, the advantages of this method and possible complications of its use in extracorporeal sepsis management in children and newborns are shown.

Abstract

The review highlights the problem of sepsis management in children and newborns by one of the methods of extracorporeal hemocorrection using special columns containing polymyxin B, which allows for the sorption of lipopolysaccharides, cytokines and inflammatory mediators, which are usually increasing in case of infectious complications. This method has not been well described in the literature sources worldwide, being represented mainly by certain clinical cases, taking into account the technical difficulties of using extracorporeal contours in premature newborns with low body weight, which makes it difficult to conduct multicenter studies with a large number of patients, as well as limited data on the use of polymyxin hemoperfusion in children. The review presents the main technical characteristics of polymyxin columns registered for use in the Russian Federation, and describes the benefits and disadvantages of the method itself. The effectiveness of polymyxin hemoperfusion in specific cases of sepsis management has been shown, and a comparative analysis of the available global data on the problem of sepsis in children and newborns has been conducted. Taking into account the heterogeneity of definitions, the problem of sepsis management with the using of polymyxin hemoperfusion requires further research to implement its widespread clinical use, which has not yet been recommended in global guidelines.

1. Ni M., Zhou J., Hu M., Zhou W., Yuan T. Global, regional, and national burden of neonatal infectious diseases from 1990 to 2021. Transl Pediatr. 2025; 14 (7): 1498-1510. doi:10.21037/tp-2025-57

2. Hartman M.E., Linde-Zwirble W.T., Angus D.C., Watson R.S. Trends in the epidemiology of pediatric severe sepsis. Pediatr Crit Care Med. 2013; 14 (7): 686-693. doi:10.1097/PCC.0b013e3182917fad

3. 3. Sepsis - World Health Organization (WHO). Available at: https://www.who.int/news-room/fact-sheets/detail/sepsis (accessed 30.10.2025)

4. 4. Neonatal Mortality - UNICEF DATA. Available at: https://data.unicef.org/topic/child-survival/neonatal-mortality (accessed 30.10.2025)

5. Murphy S.L., Kochanek K.D., Xu J.Q., Arias E. Mortality in the United States, 2023. NCHS Data Brief, no 521. Hyattsville, MD: National Center for Health Statistics. 2024. doi:10.15620/cdc/170564

6. Goldstein B., Giroir B., Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6 (1): 2-8. doi:10.1097/01.PCC.0000149131.72248.E6

7. Schlapbach L.J., Watson R.S., Sorce L.R., et al. International consensus criteria for pediatric sepsis and septic shock. JAMA. 2024; 331 (8): 665-674. doi:10.1001/jama.2024.0179

8. Watson R.S., Argent A.C., Sorce L.R., et al. The 2024 Phoenix Sepsis Score Criteria: part 1, the evolution in definition of sepsis and septic shock. Pediatr Crit Care Med. 2025; 26 (2): e246-e251. doi:10.1097/PCC.0000000000003664

9. Vesentini S., Soncini M., Zaupa A., Silvestri V., Fiore G.B., Redaelli A. Multi-scale analysis of the toraymyxin adsorption cartridge. Part I: molecular interaction of polymyxin B with endotoxins. Int J Artif Organs. 2006; 29 (2): 239-250. doi:10.1177/039139880602900210

10. Shoji H. Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (Toraymyxin). Ther Apher Dial. 2003; 7 (1): 108-114. doi:10.1046/j.1526-0968.2003.00005.x

11. Mitaka C., Kusaoi M., Kawagoe I., Satoh D. Up-to-date information on polymyxin B-immobilized fiber column direct hemoperfusion for septic shock. Acute Crit Care. 2021; 36 (2): 85-91. doi:10.4266/acc.2021.00150

12. Takeuchi O., Hoshino K., Kawai T., et al. Differential roles of TLR2 and TLR4 in recognition of gram-negative and gram-positive bacterial cell wall components. Immunity. 1999; 11 (4): 443-451. doi:10.1016/s1074-7613(00)80119-3

13. Munford R.S. Endotoxemia-menace, marker, or mistake?. J Leukoc Biol. 2016; 100 (4): 687-698. doi:10.1189/jlb.3RU0316-151R

14. Suffredini A.F., Fromm R.E., Parker M.M., et al. The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med. 1989; 321 (5): 280-287. doi:10.1056/NEJM198908033210503

15. Vesentini S., Soncini M., Fiore G.B., Redaelli A. Mechanisms of polymyxin B endotoxin removal from extracorporeal blood flow: molecular interactions. Contrib Nephrol. 2010; 167: 45-54. doi:10.1159/000315918

16. Fiore G.B., Soncini M., Vesentini S., Redaelli A. Mechanisms of polymyxin B endotoxin removal from extracorporeal blood flow: hydrodynamics of sorption. Contrib Nephrol. 2010; 167: 55-64. doi:10.1159/000315919

17. Polushin Yu.S., Sokolov D.V., Dreval R.O., Zabotina A.N. Clinical and economic evaluation of the use of selective sorption methods of extracorporeal hemocorrection in intensive care unit patients. Bulletin of Anesthesiology and Resuscitation. 2023; 20 (1): 6-16

18. Ayoub Moubareck C. Polymyxins and bacterial membranes: a review of antibacterial activity and mechanisms of resistance. Membranes (Basel). 2020; 10 (8): 181. doi:10.3390/membranes10080181

19. Nishibori M., Takahashi H.K., Katayama H., et al. Specific removal of monocytes from peripheral blood of septic patients by polymyxin B-immobilized filter column. Acta Med Okayama. 2009; 63 (1): 65-69. doi:10.18926/AMO/31855

20. Wang Y., Liu Y., Sarker K.P., et al. Polymyxin B binds to anandamide and inhibits its cytotoxic effect. FEBS Lett. 2000; 470 (2): 151-155. doi:10.1016/s0014-5793(00)01313-2

21. Ronco C., Piccinni P., Rosner M.H. Endotoxemia and endotoxin shock: disease, diagnosis and therapy. In: Extracorporeal removal of endotoxin: The polymyxin B-immobilized fiber cartridge.Tania T., Shojib H., Guadagnic G., Peregod A. Contrib Nephrol. Basel: Karger, 2010. vol 167. p. 35–44. doi:10.1159/isbn.978-3-8055-9485-1

22. State Register of Medical Devices and Organizations (Individual Entrepreneurs) Engaged in the Production and Manufacturing of Medical Devices. Medical Device Registration Number RZN 2023/20300. Available at: https://roszdravnadzor.gov.ru/services/misearch (access 30.10.2025)

23. Ibaraki S., Wada N., Yoshihui O., et al. Guidelines for acute blood purification therapy for newborns by extracorporeal circulation. Journal of the Japanese Society of Premature Infants. 2013; 25: 89-97. (In Japan.)

24. Wada N., Kasai M., Nakamura T., et al. Endotoxin removal therapy guidelines in children and newborns. Journal of the Japanese Society of Immature and Newborn Children. 2010; 22 (2): 73-75. (In Japan.)

25. Ryabtsev D.V., Lezhnev A.A., Aleksandrov A.E., et al. Analysis of the structure and risk factors for the development of complications after cardiac surgery in children according to data from a complex registry of patients with congenital heart defects in the Russian Federation. Clinical and experimental surgery. 2019; 7 (4): 7-14. (In Russ)

26. Sen A.C., Morrow D.F., Balachandran R., et al. Postoperative infection in developing world congenital heart surgery programs: data from the international quality improvement collaborative. Circ Cardiovasc Qual Outcomes. 2017; 10 (4): e002935. doi:10.1161/CIRCOUTCOMES.116.002935

27. Degtyareva E.A., Zhdanova O.I., Kufa M.A., et al. Tragedies of childhood endocarditis. Pediatrics and Neonatology. 2018; 4 (52): 86-92. (In Russ)

28. Yaroustovsky M., Abramyan M., Rogalskaya E., Komardina E. Selective polymyxin hemoperfusion in complex therapy of sepsis in children after cardiac surgery. Blood Purif. 2021; 50 (2): 222-229. doi:10.1159/000510126

29. Saetang P., Samransamruajkit R., Singjam K., Deekajorndech T. Polymyxin B hemoperfusion in pediatric septic shock: single-center observational case series. Pediatr Crit Care Med. 2022; 23 (8): e386-e391. doi:10.1097/PCC.0000000000002969

30. Sawada M., Watanabe Sh., Ogino Y., et al. Endotoxin adsorption therapy for low-weight infants - 9 example consider. Journal of the Japanese Society for Acute Blood Purification. 2012; 3 (1): 34-39. (In Japan.)

31. Kawachi M., Sawada M., Usui M., et al. Results of endotoxin adsorption therapy for newborns weighing less than 2 kg. Journal of the Japanese Society of Acute Hematology and Chemistry. 2014; 5 (2): 156-159. (In Japan.)

32. Maede Y., Ibara S., Tokuhisa T., et al. Polymyxin B-immobilized fiber column direct hemoperfusion and continuous hemodiafiltration in premature neonates with systemic inflammatory response syndrome. Pediatr Int. 2016; 58 (11): 1176-1182. doi:10.1111/ped.13006

33. Nishizaki N., Hirano D., Miyasho T., Obinata K, Shoji H., Shimizu T. Evaluation of urinary IL-6 in neonates with septic shock treated with polymyxin B-immobilized fiber column. Pediatr Int. 2017; 59 (9): 1032-1033. doi:10.1111/ped.13348

34. Nishizaki N., Hara T., Obinata K., Nakagawa M., Shimizu T. Clinical effects and outcomes after polymyxin B-immobilized fiber column direct hemoperfusion treatment for septic shock in preterm neonates. Pediatr Crit Care Med. 2020; 21 (2): 156-163. doi:10.1097/PCC.0000000000002132

35. Aldewereld Z., Carcillo J.A. Could there be a biologically plausible niche for polymyxin B-immobilized fiber column direct hemoperfusion treatment in early onset neonatal septic shock?. Pediatr Crit Care Med. 2020; 21 (2): 202-203. doi:10.1097/PCC.0000000000002164

36. Nishizaki N., Shima T., Watanabe A., Obinata K., Shimizu T. Unsatisfactory short-term neurodevelopmental outcomes of preterm infants who received polymyxin B-immobilized fiber column-direct hemoperfusion for septic shock. Tohoku J Exp Med. 2021; 253 (4): 275-281. doi:10.1620/tjem.253.275

37. Morishita Y., Kita Y., Ohtake K, et al. Successful treatment of sepsis with polymyxin B-immobilized fiber hemoperfusion in a child after living donor liver transplantation. Dig Dis Sci. 2005; 50 (4): 757. doi:10.1007/s10620-005-2569-x

38. Kihara H., Ohta T., Fukuhara R., et al. A case of neonatal gastric rupture undergoing PMX-DHP. Journal of Nephrology. 2007; 20 (1): 71-76. (In Japan.)

39. Hasegawa K., Koyama M., Ohara Sh., et al. A 6-year-old child with septic shock after idiopathic gastric rupture with endotoxin adsorption and continuous hemodiafiltration. Journal of Dialysis Society. 2011; 44 (1): 73-78. (In Japan.)

40. Hirakawa E, Ibara S, Tokuhisa T, et al. Septic neonate rescued by polymyxin B hemoperfusion. Pediatr Int. 2013;55(3):e70-e72. doi:10.1111/ped.12029

41. Tokumasu H., Watabe S., Tokumasu S. Effect of hemodiafiltration therapy in a low-birthweight infant with congenital sepsis. Pediatr Int. 2016; 58 (3): 237-240. doi:10.1111/ped.12776

42. Nishizaki N., Nakagawa M., Hara S., et al. Effect of PMX-DHP for sepsis due to ESBL-producing E. coli in an extremely low-birthweight infant. Pediatr Int. 2016; 58 (5): 411-414. doi:10.1111/ped.12825

43. Nanishi E., Hirata Y., Lee S., et al. Polymyxin-B immobilized column-direct hemoperfusion for adolescent toxic shock syndrome. Pediatr Int. 2016; 58 (10): 1051-1054. doi:10.1111/ped.13087

44. Kim Y.A., Kim H., Kim Y.M., Park S.E. A successful application of adult polymyxin B-immobilized fiber column hemoperfusion to a neonate with septic shock. Acute Crit Care. 2019; 34 (4): 284-288. doi:10.4266/acc.2017.00528

45. Nishizaki N., Shimizu T. Is exchange transfusion for severe neonatal infection preferable to polymyxin B-immobilized fiber column for direct hemoperfusion: pros and cons. Tohoku J Exp Med. 2021; 254 (2): 141-142. doi:10.1620/tjem.254.141

46. Watabe G., Watabe T., Iwatani R., et al. The standard extracorporeal circulation method was used for ultra-low birth weight infants as an attempt to adsorb endotoxins. Journal of Dialysis Society 2022; 55 (1): 25-28. (In Japan.)

47. Barbarash L.S., Grigoriev E.V., Plotnikov G.P., Shukevich D.L., Shukevich L.E. Hemodynamics and hydrodynamic status during renal replacement therapy in systemic inflammatory response of infectious and non-infectious etiology. Complex Issues of Cardiovascular Diseases. 2012; 2: 39-44. (In Russ)

48. Shimizu T., Miyake T., Tani M. History and current status of polymyxin B-immobilized fiber column for treatment of severe sepsis and septic shock. Ann Gastroenterol Surg. 2017; 1 (2): 105-113. doi:10.1002/ags3.12015

49. Evans L., Rhodes A., Alhazzani W., et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021; 47 (11): 1181-1247. doi:10.1007/s00134-021-06506-y

50. Weiss S.L., Peters M.J., Alhazzani W., et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020; 21 (2): e52-e106. doi:10.1097/PCC.0000000000002198

51. Martin-Loeches I., Nunnally M.E., Hellman J., et al. Surviving sepsis campaign: research opportunities for infection and blood purification therapies. Crit Care Explor. 2021; 3 (9): e0511. doi:10.1097/CCE.0000000000000511

52. Bellomo R., Ankawi G., Bagshaw S.M., et al. Hemoadsorption: consensus report of the 30th Acute Disease Quality Initiative workgroup. Nephrol Dial Transplant. 2024; 39 (12): 1945-1964. doi:10.1093/ndt/gfae089

53.