Evaluation of interleukin‐6, tumour necrosis factor‐α and interleukin‐1β for early diagnosis of neonatal sepsis

Abstract

Silveira RC, Procianoy RS. Evaluation of interleukin‐6, tumour necrosis factor‐α and interleukin‐1β for early diagnosis of neonatal sepsis. Acta Pædiatr 1999; 88: 647‐50. Stockholm. ISSN 0803‐5253The objective of this study was to assess the contribution of interleukin‐6 (IL‐6), tumour necrosis factor‐α (TNF‐α) and interleukin‐1β (IL‐1β) to an early diagnosis of early‐onset neonatal sepsis. A cohort of 117 newborn infants delivered during a 1‐y period had IL‐6, TNF‐α and IL‐1β, blood and cerebrospinal fluid (CSF) cultures, leucocyte and platelet count collected on the initial evaluation of possible early‐onset sepsis. They were divided into four groups: I, positive blood and/or CSF cultures; II, probably infected with clinical sepsis but negative cultures; III, same as group II but mother received antibiotic antepartum; and IV, newborn infants that did not receive any antibiotic therapy. There were no differences among the four groups with respect to mean gestational ages and birthweights, median Apgar scores, type of delivery, or number of newborn infants with leucocyte count <5000mm−3 or >25 000 mm−3, platelet count <100 000mm−3, immature/total neutrophil ratio >0.2, absolute neutrophil count <1000mm−3 and median IL‐1β levels. Median IL‐6 and TNF‐α levels were significantly higher in groups with patients with a diagnosis of clinical sepsis than in controls. The optimal cut‐off point was 32 pg ml−1 for IL‐6 and 12pgml−1 for TNF‐a. The combination of both provided a sensitivity of 98.5%. In conclusion, the combination of IL‐6 and TNF‐α is a highly sensitive marker of sepsis in the immediate postnatal period. □Cytokine, infection, newborn infant