Saito Junichi, Shibasaki Jun, Shimokaze Tomoyuki, Kishigami Makoto, Ohyama Makiko, Hoshino Rikuo, Toyoshima Katsuaki, Itani Yasufumi
Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
Am J Perinatol. 2016 Dec;33(14):1401-1406. doi: 10.1055/s-0036-1583192. Epub 2016 May 11.
C-reactive protein (CRP) is a useful marker of neonatal infection. Recent studies have shown that neonatal therapeutic hypothermia delays an elevation of CRP in infants with hypoxic-ischemic encephalopathy (HIE). This study investigated the time difference of peak levels of serum CRP and other inflammatory responses during therapeutic hypothermia. We prospectively studied the serial serum data of CRP, interleukin-6 (IL-6), procalcitonin (PCT), and complete blood counts during the first week of life in HIE infants receiving therapeutic hypothermia. We identified 22 infants who received therapeutic hypothermia between August 2013 and July 2015. No infants developed clinically overt infections. The peak of serum levels of IL-6, PCT, and CRP were postnatal days 1, 2, and 4, respectively. White blood cells, neutrophils, and platelet counts gradually decreased from days 1 to 7. Early postnatal serum levels of IL-6 correlated with CRP on day 4 (IL-6 on day 2; = 0.78, < 0.001). The peak value of CRP on day 4 might reflect the early production and secretion of IL-6 rather than an actual infection. Serial measurement of IL-6 might help avoid invasive sepsis workup and unnecessary change of antibiotics in infants.
C反应蛋白（CRP）是新生儿感染的一项有用指标。近期研究表明，新生儿治疗性低温可延迟缺氧缺血性脑病（HIE）患儿CRP的升高。本研究调查了治疗性低温期间血清CRP峰值水平及其他炎症反应的时间差异。我们前瞻性地研究了接受治疗性低温的HIE患儿出生后第一周内CRP、白细胞介素-6（IL-6）、降钙素原（PCT）的系列血清数据及全血细胞计数。我们确定了2013年8月至2015年7月期间接受治疗性低温的22例患儿。无患儿发生临床明显感染。IL-6、PCT和CRP血清水平峰值分别在出生后第1天、第2天和第4天出现。白细胞、中性粒细胞和血小板计数从第1天到第7天逐渐下降。出生后早期IL-6血清水平与第4天的CRP相关（第2天的IL-6；=0.78，<0.001）。第4天CRP的峰值可能反映了IL-6的早期产生和分泌，而非实际感染。连续测量IL-6可能有助于避免对婴儿进行侵入性脓毒症检查及不必要的抗生素更换。
