title: Tracking changes of lymphocyte subsets and pre-inflammatory mediators in full-term neonates with suspected or documented infection.
abstract: Investigation was made of changes in immune system parameters during the course of neonatal infection. The study population consisted of 95 full-term neonates matched for chronological age and sex, divided into three groups: suspected infection (n=20), sepsis (n=25), infection-free control subjects (n=50). Serial measurements were made of the cytokines interleukin-6 (IL-6), interleukin-1b (IL-1b) and tumour necrosis factor-α (TNF-α), lymphocyte subsets [CD3+, CD4+, CD8+, natural killer (NK) cells and B cells], the immunoglobulins (Ig) (IgG, IgM and IgA), C-reactive protein (CRP), and the total blood count, before, 2 days after initiation of treatment and after stopping treatment (time periods first, second and third, respectively). IL6, TNF-α, IL1-b and CRP were higher at the first time period in the sepsis group, and IL6 and TNF-α continued to be higher in this group at the second period. IL-6 and TNF-α were precise sepsis predictors with sensitivity and specificity of 0.92, 0.98 and 0.91, 0.92, respectively. NK cells, B cells, CD3+, CD4+, CD8+ were higher in the sepsis and suspected infection groups, but the ratios CD3+/CD4+, CD3+/CD8+, CD4+/CD8+ showed no difference from the controls. IgG was lower and IgM higher in the sepsis group. In the control subjects CD3+, CD4+, CD8+ lymphocytes increased with increasing age. It is concluded that IL-6 and TNF are good diagnostic markers of sepsis in full-term neonates. Lymphocyte subsets were affected by both the clinical condition and the chronological age. NK and B cells may be elevated in suspected and documented sepsis, and further studies are needed to determine their clinical significance.
authors.affiliation: Neonatal Intensive Care Unit, University Hospital of Ioannina, Ioannina, Leoforos Stavrou Niarchou, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Hotoura
authors.forename: V
authors.initials: V
authors.lastname: Giapros
authors.forename: A
authors.initials: A
authors.lastname: Kostoula
authors.forename: P
authors.initials: P
authors.lastname: Spirou
authors.forename: S
authors.initials: S
authors.lastname: Andronikou
mesh_terms: D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018836:Inflammation Mediators / Q000097:blood* / Q000276:immunology; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016131:Lymphocyte Subsets / Q000276:immunology*; D008297:Male; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D007375:Interleukin-1; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein