Cytokines patterns in newborn infants with late onset sepsis.
BACKGROUND
Cytokines might be helpful to diagnose late onset sepsis (LOS) in newborn infants. Many studies on cytokines did not discriminate culture-proven from clinically-suspected sepsis; however, such differentiation is clinically useful.


OBJECTIVE
To evaluate the feasibility to differentiate among culture-proven LOS, clinical LOS and controls using a battery of cytokines.


METHODS
This prospective study was conducted at the NICU of Harapan-Kita Women and Children's Hospital, Jakarta-Indonesia. Three groups of infants with postnatal age >72 hours of age were enrolled in the study: culture-proven sepsis group (PS) (n = 18), clinical sepsis group (CS) (n = 25) and control group (n = 34). A battery of 25 cytokines was measured in each infant five times: at enrollment, after 4 hrs, 12 hrs, 24 hrs, and 48 hrs using Invitrogen-immunoassays-Luminex™100.


RESULTS
There were no significant differences in gestational age or mode of delivery among the three groups. IL-1β, IL-2r, IL-6, IL-8, IL-10 and MIP-1a were significantly higher at all measurement points in group PS compared to controls. IL-13 was lower at all measurement moments in group CS compared to controls, IL-12 was lower and IP-10 higher between 0 and 24 hrs. IL-1Ra, IL-6, IL-8, IL-13, IL-15, TNFα, MIP-1a and MIP-1b were higher at all the measurement moments in group PS compared to group CS. The ROC curves show that IL-6, IL-8, IL-15, MIP-1a, MIP-1b and TNFα have a sensitivity and specificity between 80 and 85% during the first 24-48 hours after the onset of infection. IL-6, IL-15, MIP-1a, MIP-1b and TNFα showed the best likelihood ratios.


CONCLUSIONS
IL-6, IL8, IL 15, MIP-1a, MIP-1b and TNFα are potentially good markers for detecting a proven LOS. In case these cytokines are not elevated in sick infants, other causes than an infection have to be identified.
Department of Pediatrics, Harapan Kita Women and Children's Hospital, Jakarta, Indonesia Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, The Netherlands.
S
S
Lusyati
C V
CV
Hulzebos
J
J
Zandvoort
H
H
Sukandar
P J J
PJ
Sauer
D016022:Case-Control Studies; D016207:Cytokines / Q000378:metabolism*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*
D016207:Cytokines
Neonates; chemokines; cytokines; late onset sepsis