Diagnostic Markers for Early Detection of Neonatal Sepsis

Lara R Shoukry,Alzahraa E A Sharaf,Ahmed N Mohamed,Osama B S Osman

doi:10.47631/jsrmbs.v2i3.319

Lara R Shoukry, Alzahraa E A Sharaf + Show 2 more

Open Access

https://doi.org/10.47631/jsrmbs.v2i3.319

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Abstract

Background: Neonatal sepsis (NS) is a major health problem throughout the world. The diagnosis of sepsis is challenging due to the non-specific nature of the clinical presentation, the variety of other neonatal disorders with the differential diagnostic workup, lack of sensitivity and specificity of available diagnostic procedures, and the delay in the results of blood cultures in addition to high negative results reported. The diagnosis of suspected sepsis has to be based on clinical symptoms together with biochemical parameters. A diagnostic marker with high diagnostic sensitivity and specificity would be a valuable tool for decreasing the burden of neonatal sepsis Purpose: Evaluate the validity of interleukin-6 (IL-6) in the early diagnosis of neonatal sepsis or the use of a combination of diagnostic markers, C-reactive protein (CRP), and IL-6. Methods: The study included 30 patients with NS (Group I) and 30 healthy newborns as control (Group II) were admitted to Neonatal Intensive Care Unit (NICU) from January 2017 to June 2017. All neonates were subjected to history taking, clinical examination, and laboratory investigations including complete blood count (CBC), blood culture and sensitivity testing, CRP, and IL-6. Results: the most causative organism of neonatal sepsis in NICU was Klebsiella spp. followed by CONS. IL-6 results with cut-off value 50pg/ml, the sensitivity was 100%, the specificity was 90.32%, the positive predictive value of 90.63%, negative predictive value, and the diagnostic accuracy was 95.16. Moreover, IL-6 levels are significantly higher statistically in NS patients than controls. Conclusion: This study validated the diagnostic capability of IL-6 and showed that the combination of CRP and IL-6 as a panel for the early diagnosis of NS could enhance the sensitivity in the diagnosis of NS and may provide a new diagnostic strategy for NS patients Objective: Evaluate the validity of interleukin-6 (IL-6) in early diagnosis of neonatal sepsis or the use of combination of diagnostic markers, C-reactive protein (CRP) and IL-6. Patients and methods: The study included 30 patients with NS (Group I) and 30 apparently healthy newborns as control (Group II) were admitted to Neonatal Intensive Care Unit (NICU) from January 2017 to June 2017. All neonates were subjected to history taking, clinical examination, and laboratory investigations including: complete blood count (CBC), blood culture and sensitivity testing, CRP, and IL-6. Results: the most causative organism of neonatal sepsis in NICU was klebsiella spp. followed by CONS. IL-6 results with cut-off value 50pg/ml, the sensitivity was 100%, the specificity was 90.32%, positive predictive value of 90.63%, negative predictive value, and the diagnostic accuracy was 95.16. Moreover, IL-6 levels are significant higher statistically in NS patients than controls. Conclusion: This study validated the diagnostic capability of IL-6 and showed that the combination of CRP and IL-6 as a panel for the early diagnosis of NS could enhance the sensitivity in the diagnosis of NS and may provide a new diagnostic strategy for NS patients.

Highlights

Neonatal sepsis is the commonest cause of neonatal mortality; it is responsible for about 30 – 50% of the total neonatal deaths in developing countries
This study included a total number of 60 newborns who were classified into two groups each of 30 neonates; Group I included the newborns are diagnosed by a pediatric physician according to clinical symptoms, complete blood picture, positive Creactive protein (CRP) and positive blood culture and group II that included 30 healthy neonates
Five ml of blood samples were collected from the newborns under complete aseptic precautions in the Neonatal Intensive Care Unit (NICU), 2 ml in EDTA-vacutainer for complete blood count, 1 ml for conventional blood culture and sensitivity testing, and the remaining 2 ml were collected in plain tubes to allow samples to clot for 2 hours at room temperature before centrifugation for 15 minutes at 1000×g

Summary

Introduction

Neonatal sepsis is the commonest cause of neonatal mortality; it is responsible for about 30 – 50% of the total neonatal deaths in developing countries. It is estimated that up to 20% of neonates develop sepsis and approximately 1% die of sepsis-related causes (Ahmad et al, 2016). The reasons are mainly related to the combination of the neonatal reduced immune defense and the complex interactions between the infecting microorganisms and host response (Shane et al, 2017). C-reactive protein (CRP) is the most extensively studied acute-phase reactant so far, and despite the ongoing rise (and fall) of new infection markers, its wide availability and its simple, fast, and cost-effective determination make it one of the preferred indices in many neonatal intensive care units (NICUs) (Dulay et al, 2015). Interleuin-6 (IL-6) is the most frequently studied cytokine in the diagnosis of bacterial infections in the neonates. The concentration of IL-6 in preterm and term infants does not seem to be influenced by gestational age or maternal cytokine concentration (Sherwin et al, 2008)

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Conclusion