Abstract
The response of the adaptive immune system is usually less intense in premature neonates than term neonates. The primary objective of this study was to determine whether immunological parameters vary between preterm (PT) neonates (≥32 weeks of gestational age) and very preterm (VPT) neonates (<32 weeks of gestational age). A cross-sectional study was designed to prospectively follow PT and VPT neonates at risk of developing sepsis. Plasma concentrations of IFN-γ, TNF-α, IL-6, IL-4, and IL-10 were detected using flow cytometry. C-reactive protein (C-RP) and the complex SC5b-9 were detected in the plasma using commercial kits. A total of 83 patients were included. The laboratory results and clinical histories showed that 26 patients had sepsis; 14 were VPT, and 12 were PT. The levels of C-RP, SC5b-9 (innate immune response mediators), and IL-10 or IL-4 (anti-inflammatory cytokines) were elevated during sepsis in both groups. IFN-γ, TNF-α, and IL-6 (proinflammatory cytokines) were differentially elevated only in PT neonates. The VPT neonates with sepsis presented increases in C-RP, SC5b-9, and anti-inflammatory cytokines but not in proinflammatory cytokines, whereas PT neonates showed increases in all studied mediators of inflammation.
Highlights
Neonatal sepsis affects up to 20% of very low birth weight premature newborns, causing death in up to 18% of these newborns
This study investigated the innate and adaptive immune response mediators in neonates of different gestational ages (GAs) who were at risk of developing sepsis
The proinflammatory cytokines (TNF-α, IFN-γ, and IL-6) increase differentially in neonates with sepsis based on gestational age
Summary
Neonatal sepsis affects up to 20% of very low birth weight premature newborns, causing death in up to 18% of these newborns. The health of neonates can deteriorate quickly, and the newborns can develop septic shock and die before agent identification and antimicrobial sensitivity tests are ready. Because inflammation is an important event in the sepsis process, many studies have focused on measuring inflammatory mediators to permit an early diagnosis of sepsis [1,2,3,4,5,6]; systematic reviews [7] reveal that the sensitivity of sepsis diagnosis through inflammatory mediators varied, and additional studies are required. The data are very scarce for preterm neonates, and relatively large discrepancies are reported amongst studies. Discrepancies might originate from the fact that gestational age is usually not considered when the mediators of inflammation are analysed, even when the immune response in neonates is likely to be immature. IL-6, IFNα, and TNF-α production in monocytes and conventional
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