Abstract
ObjectiveCytokines (IL-6, IL-8 and TNF-α), sCD163, and C-reactive protein were serially measured in an attempt to identify a set of tests which can reliably confirm or refute the diagnosis of neonatal sepsis at an early stage.MethodsOne hundred neonates suspected to have sepsis on clinical grounds and who met the inclusion criteria were enrolled for the study. Based on the positive or negative blood culture reports they were classified as infected (n = 50) and non-infected (n = 50) neonates respectively. Fifty healthy neonates without any signs of sepsis were also included in the study as control group. The initial blood sample was taken on day 0 (at the time of sepsis evaluation) and two further samples were taken on days 1 and 2 for monitoring the clinical progress and response to treatment. In the control group the cord blood and 48 hours venous sample was collected. Plasma CRP (ng/ml), IL-6 (pg/ml), IL-8 (pg/ml), TNF-α (ng/ml) and sCD163 (ng/ml) were determined by double antibody method Enzyme Linked Immunosorbent Assay in all the three blood samples.ResultsThe cut of levels for CRP at >19,689 ng/ml had a sensitivity of 68%, specificity of 92%, for IL-6 at >95.32 pg/ml had a sensitivity of 54%, specificity of 96%, for IL-8 at >70.86 pg/ml had a sensitivity of 78%, specificity of 70%, for sCD163 at >896.78 ng/ml had a sensitivity of 100%, specificity of 88% for the diagnosis of infection before antibiotics. TNF-α levels of >12.6 ng/ml showed 100% sensitivity and 72% specificity for the diagnosis of inflammation.ConclusionThe most powerful predictor to differentiate between the non-infected and infected neonates before antibiotics was sCD163. The most powerful indicator for evaluation of prognosis is IL-6. sCD163 can be used alone to screen for sepsis in neonates before the results of blood culture are received.
Highlights
Bacterial sepsis is one of the major causes of neonatal morbidity and mortality [1]
Cytokines (IL-6, IL-8 and TNF-a), sCD163, and a commonly used acute phase reactant protein (C reactive protein) were serially measured in this study in an attempt to identify a set of tests which can reliably confirm or refute the diagnosis of systemic infection at an early stage in an economical way
This study was done for a period of two years and we have estimated C-reactive protein (CRP), IL-6, IL-8, TNF-a and sCD163 in the serum of the infected, non-infected and control neonates before antibiotics, at 24 hours after antibiotics and at 48 hours after antibiotics
Summary
Bacterial sepsis is one of the major causes of neonatal morbidity and mortality [1]. Prevention and control of these infections are major challenges for neonatal intensive care units (NICUs). Bacterial cultures are time-consuming and other laboratory tests are either not available for routine assay or lack sensitivity or specificity. In this situation, neonates with risk factors for infection or clinical suspicion of infection are empirically treated with antibiotics. To avoid unnecessary treatment of noninfected neonates, an early, sensitive and specific laboratory test would be helpful to guide clinicians in neonatal units to decide whether or not to start antibiotics. Over the past few decades, some of the commonly used markers in clinical practice, especially leukocyte indexes and acute-phase reactants have been tried for early detection of neonatal sepsis
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