Plasma endothelin-1 and clinical manifestations of neonatal sepsis.
OBJECTIVE
To determine whether plasma endothelin-1 (ET-1) relates to clinical manifestations of sepsis in the newborn, especially with systemic hypotension, acidosis, severe hypoxemia (which may represent pulmonary hypertension) and oliguria.


METHODS
Prospective study of 35 consecutive newborns with clinical sepsis: 22 with hemoculture-positive (HC+) sepsis and 13 hemoculture-negative (HC-). Plasma ET-1 concentrations were measured within 2 days of the diagnosis of sepsis. SNAP-II severity score was performed at the time of highest clinical severity.


RESULTS
Newborns with HC+ sepsis had higher plasma ET-1 concentrations and SNAP-II scores (especially PO 2 /FiO 2 ratio) than HC- septic children. Plasma ET-1 concentrations increased linearly with each item of the SNAP-II score, but only reached significant differences in lowest mean blood pressure (P=0.030), lowest pH (P=0.048), multiple seizures (P=0.010) and lowest urine output (P=0.013). Leukocyte count, immature/total neutrophil ratio and C-reactive protein value were not different. Each item of the SNAP-II score was independently related only to ET-1 level. Oliguria, acidosis and systemic hypotension were more correlated (R 2 >0.5).


CONCLUSIONS
Plasma ET-1 levels in neonatal sepsis are related to the severity of clinical manifestations, especially oliguria, acidosis and systemic hypotension.
Figueras-Aloy
José
J
Neonatal Service, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Unitat Integrada de Pediatria, Hospital Clinic, 08028 Barcelona, Spain. jfiguer@clinic.ub.es
Gómez-Lopez
Lilian
L
Rodríguéz-Miguélez
J Manuel
JM
Jordán-García
Yolanda
Y
Salvia-Roiges
M Dolores
MD
Jiménez
Wladimiro
W
Carbonell-Estrany
Xavier
X
D000138:Acidosis / Q000150:complications; D002175:Candida / Q000302:isolation & purification; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007022:Hypotension / Q000150:complications; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000473:pathology; D007363:Intensive Care Units, Neonatal; D008297:Male; D009846:Oliguria / Q000150:complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D012720:Severity of Illness Index; D013030:Spain
D019332:Endothelin-1