title: Predictive value of soluble immunological mediators in neonatal infection.
abstract: 1. Infection in the neonatal period is difficult to diagnose and is a significant cause of morbidity and mortality in preterm infants. 2. We investigated prospectively the predictive value of plasma measurement of bacterial endotoxin (lipopolysaccharide), tumour necrosis factor-alpha, interleukin-6, interleukin-8, intercellular adhesion molecule-1 and C-reactive protein in 60 consecutive newborn infants suspected of having neonatal infection. Plasma samples were taken at the time of acute clinical deterioration. Sixty-two cord blood samples were studied as controls taken at elective Caesarean section. 3. Forty-three infants had confirmed infections, 25 with positive blood cultures. Tumour necrosis factor-alpha and bacterial endotoxin levels were not significantly elevated over controls, whereas interleukin-6, interleukin-8 and intercellular adhesion molecule-1 levels were all significantly increased in the infected group compared with controls (all P < 0.001). 4. Increased plasma intercellular adhesion molecule-1 levels were a highly sensitive (88%) indicator of clinical infection and were independent of C-reactive protein. Use of these two assays in combination improved the diagnostic sensitivity to 95% and gave a negative predictive value of 97%. addition of interleukin-6 or interleukin-8 measurements failed to further significantly enhance the prediction of infection. 5. Measurement of intercellular adhesion molecule-1 level may have a clinical role in rapidly confirming, or predicting, the likely diagnosis in cases of suspected neonatal infection.
authors.affiliation: Department of Immunology, University Hospital NHS Trust, Queen's Medical Centre, Nottingham, U.K.
authors.forename: J D
authors.initials: JD
authors.lastname: Edgar
authors.forename: D C
authors.initials: DC
authors.lastname: Wilson
authors.forename: S A
authors.initials: SA
authors.lastname: McMillan
authors.forename: A D
authors.initials: AD
authors.lastname: Crockard
authors.forename: M I
authors.initials: MI
authors.lastname: Halliday
authors.forename: K R
authors.initials: KR
authors.lastname: Gardiner
authors.forename: B J
authors.initials: BJ
authors.lastname: Rowlands
authors.forename: H L
authors.initials: HL
authors.lastname: Halliday
authors.forename: T A
authors.initials: TA
authors.lastname: McNeill
mesh_terms: D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002585:Cesarean Section; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis*; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein