Rite Gracia S, Grasa Ullrich J M, Ruiz de la Cuesta Martín C, Grasa Biec J M, Rebage Moisés V, Marco Tello A, Rite Montañés S
Unidad Neonatal, Servicio de Pediatría, Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, España.
An Pediatr (Barc). 2003 Sep;59(3):246-51.
Neonatal infection is a major cause of morbidity in the neonatal period. Several parameters have been used to assess neonatal sepsis. C-reactive protein (CRP) shows high specificity for bacterial infections, but an increase in CRP is often not detected until 12 to 24 hours after onset of the infection.
To evaluate the usefulness of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in the early diagnosis of vertically-transmitted neonatal bacterial infection.
Thirty-four newborns admitted to the neonatal intensive care unit with an initial diagnosis of respiratory distress were included. Twelve newborns presented the criteria for clinical sepsis or pneumonia (group I) and six had positive blood culture. The remaining patients did not present the clinical criteria for infection (group II). IL-6, TNF-alpha, CRP levels and the ratio between immature and mature neutrophil count were assessed at 8.8 +/- 7.3 hours of life. In 17 patients the same parameters were assessed at 67.4 +/- 24.8 hours of life. The statistical analysis was performed using the Mann-Whitney test. The sensitivity and specificity of these markers were assessed.
No differences were found in the perinatal features of either group. Analysis of markers of infection revealed the following significant differences: ratio between immature and mature neutrophil count: (0.25 +/- 0.21 vs 0.12 +/- 0.09; p=0.048), CRP first determination (1.4 +/- 0.8 mg/dL vs 1 +/- 0.5 mg/dL; p=0.036), CRP second determination: (3.8 +/- 1.8 mg/dL vs 1.4 +/- 1.1 mg/dL; p=0.008), IL-6 first determination: (582.2 +/- 810.5 pg/mL vs 31.3 +/- 24.2 pg/mL; p=0.000). Sensitivity/specificity (%): ratio between immature and mature neutrophil count: 41.6/83.6; CRP first determination: 16.6/90.9; CRP second determination: 83.3/87.5; IL-6 (optimum cut-off value: 55 pg/mL): 100/72.7, and TNF-alpha: 16.6/85.
IL-6 determination in the first hours of life is a more sensitive early marker of neonatal infection than other classical markers because of its early elevation. Like CRP, early TNF-alpha determination has high specificity but low sensitivity.
新生儿感染是新生儿期发病的主要原因。已有多项参数用于评估新生儿败血症。C反应蛋白（CRP）对细菌感染具有高度特异性，但通常在感染发作后12至24小时才会检测到CRP升高。
评估白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）在垂直传播的新生儿细菌感染早期诊断中的作用。
纳入34例入住新生儿重症监护病房、初步诊断为呼吸窘迫的新生儿。12例新生儿符合临床败血症或肺炎标准（I组），6例血培养阳性。其余患者不符合感染临床标准（II组）。在出生后8.8±7.3小时评估IL-6、TNF-α、CRP水平以及未成熟与成熟中性粒细胞计数之比。17例患者在出生后67.4±24.8小时评估相同参数。采用Mann-Whitney检验进行统计分析。评估这些标志物的敏感性和特异性。
两组围产期特征无差异。感染标志物分析显示以下显著差异：未成熟与成熟中性粒细胞计数之比：（0.25±0.21对0.12±0.09；p=0.048），首次测定CRP（1.4±0.8mg/dL对1±0.5mg/dL；p=0.036），第二次测定CRP：（3.8±1.8mg/dL对1.4±1.1mg/dL；p=0.008），首次测定IL-6：（582.2±810.5pg/mL对31.3±24.2pg/mL；p=0.000）。敏感性/特异性（%）：未成熟与成熟中性粒细胞计数之比：41.6/83.6；首次测定CRP：16.6/90.9；第二次测定CRP：83.3/87.5；IL-6（最佳截断值：55pg/mL）：100/72.7，TNF-α：16.6/85。
由于IL-6在出生后数小时内早期升高，因此与其他经典标志物相比，它是新生儿感染更敏感的早期标志物。与CRP一样，早期测定TNF-α具有高特异性但低敏感性。
