B.E. Gonzalez, C.K. Mercado, L. Johnson, N. L. Brodsky, V. Bhandari
Early markers of late-onset sepsis in premature neonates: clinical,
hematological and cytokine profile
Background: Late-onset sepsis in the NICU is a major
problem associated with high morbidity and mortality.
Objective: To determine if clinical characteristics, hematological
parameters and serial measurements of serum
IL-6 and IL-8 can detect late-onset sepsis in premature
neonates prior to positive blood cultures.
Design: The study was done in 2 phases. The first phase
(S1) was a retrospective evaluation of clinical signs and
timing of blood culture positivity in all neonates with
late-onset culture proven sepsis from 1991–1998. The
second phase (S2) was a prospective study that enrolled
infants ?72 hours old, suspected of sepsis based on the
presence of criteria identified in S1. At that time (day 0),
blood was drawn for a CBC with differential, blood culture,
IL-6 and IL-8 levels; cytokine levels were repeated
on day 1. Infants with positive cultures were diagnosed as
confirmed sepsis; those with negative cultures, as no sepsis.
Results: S1: Of the 48 episodes of culture proven, late-onset
sepsis, 54% of the blood cultures were positive by
24 hours and 90% by 48 hours. The most common presenting
signs were desaturations (50%) and increased
gastric residuals (33%); I/T ratio > 0.16 differentiated
between gram-positive, negative and fungal infections
(p = 0.007). S2: 27 infants were enrolled. Eight (mean
[SEM] gestational age of 28.2 [0.94] weeks; birth weight
of 1.15 [0.11] kg) had positive blood cultures; 19 (gestational
age of 27.7 [0.9] weeks; birth weight of 1.06 [0.13]
kg) had no sepsis. Infants with sepsis were more likely to
have apnea/bradycardia (p = 0.002); no differences in
hematological profile, as compared to those with no sepsis.
Seven (88%) infants had positive blood cultures by
48 hours. Median values of IL-6 (pg/ml) were higher in
infants with sepsis vs. those with no sepsis on days 0 [40
vs.13] (p = 0.03) and 1 [24 vs. 9] (p < 0.001). IL-8 levels
were not significantly different.
Conclusions. In both S1 and S2, a majority of the blood
cultures were positive by 48 hours. IL-6 levels on days 0
and 1 were significantly higher in infants with confirmed
sepsis, prior to the blood culture being positive. IL-6 levels
may be useful in the initiation as well as early termination
of antibiotic therapy in late-onset neonatal sepsis.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 31, 01/2003
Pages: 60 - 68
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