Neunhoeffer F, Dabek M T, Renk H, Rimmele P, Poets C, Goelz R, Orlikowsky T
Department of Paediatric Cardiology, Pulmology and Paediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany.
Neonatology/FIPS, Childrens' Hospital Heidelberg, Heidelberg, Germany.
Klin Padiatr. 2015 Mar;227(2):66-71. doi: 10.1055/s-0034-1395552. Epub 2015 Feb 4.
For quick detection of neonatal early-onset bacterial infection (EOBI) pro-inflammatory cytokines like Interleukin-6 (IL-6) and Interleukin-8 (IL-8) in combiantion with C-reactive Protein (CRP) have been used. Automated determination of immature myeloid information (IMI) seems to be an additional useful tool in the diagnosis of NBI.
To compare the diagnostic value of IMI, I/T-Ratio, plasma IL-6 and IL-8 levels and CRP in term and preterm neonates at time of clinical suspicion of EOBI.
31 preterm and 123 term neonates with clinical and serological signs of EOBI were analysed. 91 preterm and 159 term neonates with risk factors but without proven EOBI served as non-infected controls.
Neonates with EOBI showed significantly elevated IMI levels at time of first clinical suspicion of EOBI (Preterm: 1 028/µL (38-8 759) vs. 289/µL (6-3 126); Term: 1 268/µL (48-14 035) vs. 856/µL (19-5 735); p<0.05 respectively). I/T-Ratio, IL-6, IL-8 and CRP values were significantly higher in preterm and term neonates with EOBI (p<0.05). Sensitivity of IMI at a cut-off level of 650/µL was 84.2% [95%-CI: 74.0-91.6%] in preterm and 65.4% [95%-CI: 56.8-73.3%] in term infants. Specificity was 66.7% [95%-CI: 47.1-82.7%] and 53.9% [95%-CI: 43.8-63.7%], respectively. Combination of different infection parameters improved sensitivity up to 93.5% and specificity up to 98.9%.
The diagnostic value of IMI in diagnosing EOBI in preterm and term neonates is not comparable to IL-6, IL-8 and CRP. Combination of IMI-Channel with IL-6, IL-8 or CRP improves their sensitivity, specificity and predictive value.
为快速检测新生儿早发型细菌感染（EOBI），已采用白细胞介素-6（IL-6）和白细胞介素-8（IL-8）等促炎细胞因子与C反应蛋白（CRP）联合检测的方法。自动测定未成熟髓系信息（IMI）似乎是诊断新生儿细菌感染（NBI）的另一种有用工具。
比较在临床怀疑患有EOBI时，IMI、I/T比值、血浆IL-6和IL-8水平以及CRP在足月儿和早产儿中的诊断价值。
分析了31例早产和123例足月且有EOBI临床及血清学体征的新生儿。91例早产和159例足月有危险因素但未证实患有EOBI的新生儿作为未感染对照。
在首次临床怀疑患有EOBI时，患有EOBI的新生儿IMI水平显著升高（早产：1028/μL（38 - 8759）对289/μL（6 - 3126）；足月：1268/μL（48 - 14035）对856/μL（19 - 5735）；p均<0.05）。患有EOBI的早产儿和足月儿I/T比值、IL-6、IL-8和CRP值显著更高（p<0.05）。IMI在截断值为650/μL时，早产儿的敏感性为84.2%[95%置信区间：74.0 - 91.6%]，足月儿为65.4%[95%置信区间：56.8 - 73.3%]。特异性分别为66.7%[95%置信区间：47.1 - 82.7%]和53.9%[95%置信区间：43.8 - 63.7%]。不同感染参数联合使用可将敏感性提高至93.5%，特异性提高至98.9%。
IMI在诊断早产儿和足月儿EOBI方面的诊断价值不如IL-6、IL-8和CRP。IMI通道与IL-6、IL-8或CRP联合使用可提高它们的敏感性、特异性和预测价值。
