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induced changes in cell-mediated lympholysis: to immunize or not to immunize J Immunol 1991;147:3348-3352 272 Tartter PI Immunologic effects of blood transfusion Immunol Invest 1995;24:277-288 273 Shroff R, Ledermann S Long-term outcome of chronic dialysis in children Pediatr Nephrol 2009;24:463-474 274 Lim WH, Kireta S, Leedham E, Russ GR, Coates PT Uremia impairs monocyte and monocyte-derived dendritic cell function in hemodialysis patients Kidney Int 2007;72:1138-1148 275 Lim WH, Kireta S, Russ GR, Coates PT Uremia impairs blood dendritic cell function in hemodialysis patients Kidney Int 2007;71:1122-1131 276 Betjes MG Immune cell dysfunction and inflammation in endstage renal disease Nat Rev Nephrol 2013;9:255-265 277 Siegrist CA, Aspinall R B-cell responses to vaccination at the extremes of age Nat Rev Immunol 2009;9:185-194 278 Al-Hertani W, Yan SR, Byers DM, Bortolussi R Human newborn polymorphonuclear neutrophils exhibit decreased levels of MyD88 and attenuated p38 phosphorylation in response to lipopolysaccharide Clin Invest Med 2007;30:E44-E53 279 Mathias B, Mira JC, Rehfuss JP, et al LPS stimulation of cord blood reveals a newborn-specific neutrophil transcriptomic response and cytokine production Shock 2017;47:606-614 280 Arinola OG, Obisesan KA, Afolabi K, Salimonu LS Complement levels and leucocyte phagocytosis in newborn babies Afr J Med Med Sci 2003;32:401-404 e8 Abstract: Many factors affecting critically ill children in the pediatric intensive care unit can affect innate and adaptive immune responses, causing a secondary immunodeficient state The most common factors are sepsis, malnutrition, and human immunodeficiency virus/acquired immunodeficiency syndrome Acquired immune dysfunction increases the risk of infectious organisms, especially nosocomial infections and latent reactivation The approach to secondary immunodeficient patients requires selective surveillance and a low threshold for empiric antimicrobial therapies Patterns of infections characteristic of specific immunodeficient states can be recognized, but unusual presentations are always possible In addition to antimicrobial therapies, immunomodulation therapies may be part of the physician’s future armamentarium Key words: Innate immunity, adaptive immunity, immunodeficiency, sepsis, malnutrition, HIV/AIDS, immunosuppression, opportunistic infections ... attenuated p38 phosphorylation in response to lipopolysaccharide Clin Invest Med 2007;30:E44-E53 279 Mathias B, Mira JC, Rehfuss JP, et al LPS stimulation of cord blood reveals a newborn-specific neutrophil