title: T cell cytokines and the risk of blood stream infection in extremely low birth weight infants.
abstract: Cytokines mediate the host immune response to infectious micro-organisms. The objective of this study was to determine whether immune regulatory interleukins (IL-4, IL-5, IL-6, and IL-10) and inflammatory cytokines (Interferon-γ [INF-γ], tumor necrosis factor-β [TNF-β], IL-2, and IL-17) are associated with an increased risk of developing blood stream bacterial/fungal infection (BSI) in extremely low birth weight (ELBW) infants. ELBW infants from 17 NICHD Neonatal Research Network centers without early onset sepsis were studied. Cytokines were measured from blood on days 1, 3, 7, 14, and 21 after birth. 996 ELBW infants contributed a minimum of 4080 unique measurements for each cytokine during the five sampling periods. Infants with BSI had lower levels of the inflammatory cytokines IL-17 (p=0.01), and higher levels of the regulatory cytokines, IL-6 (p=0.01) and IL-10 (p<0.001). Higher levels of regulatory cytokines relative to pro-inflammatory cytokines were associated with increased risk of BSI even after adjusting for confounding variables. In ELBW infants, the ratio of immune regulatory cytokines to inflammatory cytokines was associated with development of BSI. Altered maturation of regulatory and inflammatory cytokines may increase the risk of serious infection in this population.
authors.affiliation: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. schelonk@ohsu.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Schelonka
authors.forename: Akhil
authors.initials: A
authors.lastname: Maheshwari
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Sarah
authors.initials: S
authors.lastname: Taylor
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.forename: Diana E
authors.initials: DE
authors.lastname: Schendel
authors.forename: Poul
authors.initials: P
authors.lastname: Thorsen
authors.forename: Kristin
authors.initials: K
authors.lastname: Skogstrand
authors.forename: David M
authors.initials: DM
authors.lastname: Hougaard
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D016207:Cytokines / Q000097:blood*; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000097:blood* / Q000276:immunology*; D007231:Infant, Newborn; D007239:Infections / Q000097:blood* / Q000276:immunology*; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D013601:T-Lymphocytes / Q000378:metabolism*; D018417:Th1 Cells / Q000166:cytology / Q000276:immunology; D058504:Th17 Cells / Q000166:cytology / Q000276:immunology; D018418:Th2 Cells / Q000166:cytology / Q000276:immunology; D013997:Time Factors
chemical_list: D016207:Cytokines