title: Tumor necrosis factor alpha -- 308 polymorphism associated with increased sepsis mortality in ventilated very low birth weight infants.
abstract: BACKGROUND
  Sepsis commonly complicates the clinical course of critically ill very low birth weight infants, with as many as 30% developing hospital-acquired bacteremia. The tumor necrosis factor alpha (TNF-alpha) -- 308 G/A single nucleotide polymorphism (SNP) is associated with adverse outcome in septic adult patients.
  
  
  METHODS
  One hundred seventy-three mechanically ventilated very low birth weight infants were genotyped for the TNF-alpha -- 308 G/A SNP.
  
  
  RESULTS
  One hundred twenty (69%) infants were homozygous GG, 45 (26%) were heterozygous AG and 8 (5%) were homozygous AA; 2 of 120 (2%) infants developed early bacteremia in the GG group, and 1 of 53 (2%) developed early bacteremia in the AA/AG group (P = 0.919). One or more episodes of late bacteremia/fungemia developed in 59 of 120 (49%) infants with the GG genotype and 23 of 53 (43%) infants with the AG/AA genotype (P = 0.484). Endotracheal tube colonization rates were 65 of 120 (54%) for infants with the GG genotypes and 28 of 53 (53%) for infants with the AG/AA genotypes (P = 0.871). Nosocomial pneumonia developed in a similar number of infants in both genotype groups (9 of 120 infants vs. 3 of 53 infants; P = 0.461). Mortality from sepsis was 3 times greater in infants with the AA/AG genotypes than in those with the GG genotype (10%vs. 3%; P = 0.038). This difference in sepsis mortality was even greater when only bacteremic/fungemic infants are considered (4 of 59 infants vs. 6 of 23 infants; P = 0.026).
  
  
  CONCLUSIONS
  These data suggest that the TNF-alpha -- 308 A allele does not affect the development of sepsis in ventilated premature infants but may increase mortality once sepsis develops.
authors.affiliation: Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Hedberg
authors.forename: Kim
authors.initials: K
authors.lastname: Adcock
authors.forename: Jeremy
authors.initials: J
authors.lastname: Martin
authors.forename: John
authors.initials: J
authors.lastname: Loggins
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kruger
authors.forename: R John
authors.initials: RJ
authors.lastname: Baier
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology / Q000401:mortality*; D016022:Case-Control Studies; D016469:Fungemia / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D020641:Polymorphism, Single Nucleotide; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics*; D012122:Ventilators, Mechanical
chemical_list: D014409:Tumor Necrosis Factor-alpha