To investigate further the susceptibility to infection of newborn infants, particularly those born prematurely, we have used a "whole blood" flow cytometric assay to compare the respiratory burst activity in recombinant human granulocyte-macrophage colony stimulating factor "primed" neutrophils obtained from healthy adults, term infants, and preterm newborn infants. The use of whole blood avoids prior cell separation procedures that may cause artifactual activation or priming. In healthy adults (n = 21), the bacterial cell wall peptide N-formyl-methionyl-leucyl-phenylalanine induced little neutrophil respiratory burst activity, suggesting that the circulating cell is relatively quiescent. Prior exposure to recombinant human granulocyte-macrophage colony stimulating factor augmented the median N-formyl-methionyl-leucyl-phenylalanine response by 425%. In cord blood from full-term neonates (n = 9), recombinant human granulocyte-macrophage colony stimulating factor produced less enhancement of the N-formyl-methionyl-leucyl-phenylalanine response (345%), but the absolute level of respiratory burst activity was at least as great as in adults, suggesting that the neutrophils are fully functional and partially primed after delivery. In preterm infants receiving intensive care (n = 10), the degree of priming was similar to that in neutrophils from term infants (344%), although the absolute level of respiratory burst activity was reduced (p = 0.0003). In response to stimulation with phorbol ester, 73.5% (18-99%) (median and range) of neutrophils obtained from adults and 77.6% (50-92%) from term babies exhibit respiratory burst activity detectable in the whole blood assay. However, in neutrophils obtained from preterm infants, there was a significant reduction in the phorbol ester-induced respiratory burst, with only 32.9% (21-61%) of cells responding (p = 0.0129).