Changes in serum procalcitonin, interleukin 6, interleukin 8 and C-reactive protein in neonates after surgery.

INTRODUCTION

Aim of this study was to determine the kinetics of procalcitonin (PCT), interleukin-6 (IL-6), interleukin-8 (IL-8) and C-reactive protein (CRP) serum concentrations after different types of neonatal surgery.

MATERIAL AND METHODS

We conducted a prospective, observational study in a level III multidisciplinary neonatal intensive care unit. We enrolled twenty-five (n=25) neonates undergoing major surgery (for gastroschisis, atresia of the small intestine, congenital diaphragmatic hernia, esophageal atresia, coarctation of the aorta, neurosurgical procedures). Serum PCT, IL-6, IL-8 and CRP were measured before surgery, immediately after surgery (POD 0) and on the first and second day after surgery (POD 1, 2).

RESULTS

Median preoperative serum concentrations were: PCT 1.3 microg/l, IL-6 985 fmol/l, IL-8 51 pg/ml, CRP 6 mg/l. PCT increased insignificantly after surgery with a peak median concentration on POD 1 (2.0 microg/l), but concentrations varied considerably between patients in the same category of surgery. IL-6 significantly increased on POD 0 (median 2 262 fmol/l), with a peak median concentration on POD 1 (3 410 fmol/l), and decreased thereafter. IL-8 increased significantly after surgery with a peak median concentration on POD 0 (125 pg/ml) and decreased thereafter. IL-8 response was very consistent after all types of surgery. CRP only began to increase on POD 1 (median 20 mg/l) with a peak median concentration on POD 2 (21 mg/l).

CONCLUSIONS

The physiological increase in PCT after birth and the impact of underlying disease make the interpretation of postoperative values in the immediate postnatal period difficult. IL-6 is a very sensitive marker of neonatal surgical injury with considerable variation between different types of surgery. IL-8 response after neonatal surgery is similar after all types of surgery, very rapid and transient with relatively low concentrations. CRP response to surgery is slow with persistence of elevated levels throughout the study period. IL-8 could potentially be a useful marker for monitoring infection in the immediate postoperative period in neonates.