Serum Interleukin-6 Levels in the Differential Diagnosis of Sepsis and Transient Tachypnea of Newborn

Abstract

Objective: The aim of this study was to evaluate the role of serum interleukin-6 (IL-6) levels in the differentiation of neonatal bacterial sepsis and TTN. Material and Methods: The hospital records of 58 newborn infants with respiratory distress who were above 35 weeks of gestational age were investigated. Patients were divided into two groups. The infection group consisted of patients with proven sepsis and clinical sepsis and the other was the TTN group. Clinical findings and white blood cell count, serum C-reactive protein (CRP), IL-6 levels and the ratio of immature neutrophils to total neutrophils count (I/T) were recorded and compared between the two groups. Results: Serum CRP and IL-6 levels were found higher than the normal limits in both of the groups. However there was no significant difference between them. Duration of respiratory distress was longer and I/T ratio significantly higher in the infection group than the TTN group. The combination of IL-6 and I/T ratio yielded a sensitivity of 80%, a specificity of 48%, a positive predictive value of 44.7%, and a negative predictive value of 80% Conclusion: The I/T ratio and IL-6 may contribute to the early diagnosis of sepsis with respiratory symptoms in newborn infants but IL-6 alone cannot distinguish between TTN and sepsis. Turkish Başlık: Yenidoğanlarda Sepsis ve Yenidoğanın Geçici Takipnesinin Ayırıcı Tanısında Serum İnterlökin-6 Düzeyleri Anahtar Kelimeler: İnterlökin 6; sepsis; yenidoğan; yenidoğanın geçici takipnesi Amaç: Bu çalışmanın amacı yenidoğanlarda serum interlökin 6 düzeyinin bakteriyel sepsis ve yenidoğanın geçici takipnesinin ayrımında rolünün araştırılması. Gereç ve Yöntemler: Solunum sıkıntısı olan ve gestasyonel yaşı 35 haftadan büyük olan 58 yenidoğan çalışmaya alındı. Hastalar kanıtlanmış veya klinik sepsisi olanlar ve yenidoğanın geçici takipnesi olanlar olmak üzere iki gruba ayrıldı. Klinik bulgular beyaz küre sayısı, C reaktif protein, serum IL-6 düzeyi, periferik yaymada immature nötrofil sayısının toplam nötrofil sayısına oranı kaydedilerek gruplar arasında karşılaştırıldı. Bulgular: Her iki grupta da serum CRP ve IL-6 düzeyleri normal limitlerden yüksek bulunmasına rağmen iki grup arasında fark yoktu. Solunum sıkıntısının süresi ve I/T oranı kanıtlanmış veya klinik sepsisi olan grupta belirgin olarak fazla bulundu. IL-6 ve I/T oranı kombine olarak yenidoğan sepsisi erken tanısında birlikte kullanıldığında, duyarlılık %80, özgüllük ise %48 tespit edildi. Sonuç: IL-6 ve I/T oranı solunum sıkıntısı olan sepsisli yenidoğanların erken tanısı konusunda katkıda bulunurken IL-6 düzeyi tek başına yenidoğanlarda sepsis ve yenidoğanın geçici takipnesinde kullanılamaz.

Keywords

• Interleukin 6; sepsis; newborn; transient tachypnea

Kaynakça

1. Eicher DJ, Annibale DJ. Neonatal sepsis: evaluation and management. J S C Med Assoc 2002;98:106-12.
2. Källman J, Ekholm L, Eriksson M, Malmström B, Schollin J. Contribution of interleukin-6 in distinguishing between mild respiratory disease and neonatal sepsis in the new- born infant. Acta Paediatr 1999;88:880-4.
3. Doellner H, Arntzen KJ, Haereid PE, Aag S, Austgulen R. Interleukin-6 concentrations in neonates evaluated for sep- sis. J Pediatr 1998;132:295-9.
4. Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, et al. C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal com- plications, and infection. Clin Chem 2003;49: 60-8.
5. Miller LC, Isa S, LoPreste G, Schaller JG, Dinarello CA. Neonatal interleukin-1 beta, interleukin-6, and tumor necrosis factor: cord blood levels and cellular production. J Pediatr 1990;117:961-5.
6. Philip AG, Hewitt JR. Early diagnosis of neonatal sepsis. Pediatrics 1980;65:1036-41.
7. Liao J, Keiser JA, Scales WE, Kunkel SL, Kluger MJ. Role of epinephrine in TNF and IL-6 production from isolated perfused rat liver. Am J Physiol 8. Takaki A, Huang QH, Somogyvári-Vigh A, Arimura A. Immobilization stress may increase plasma interleukin-6 via central and peripheral catecholamines. Neuroimmunomodulation 1994;1:335-42.
8. Ng PC, Cheng SH, Chui KM, Fok TF, Wong MY, Wong W et al. Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1997;77:F221-7.

9. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997;16:735-46.
10. Shim SS, Romero R, Jun JK, Moon KC, Kim G, Yoon BH. C-reactive protein concentration in vaginal fluid as a mark- er for intra-amniotic inflammation/infection in preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2005;18:417-22.
11. Xanthou M, Fotopoulos S, Mouchtouri A, Lipsou N, Zika I, Sarafidou J. Inflammatory mediators in perinatal asphyxia and infection. Acta Paediatr Suppl 2002;91:92-7.
12. Ainbender E, Cabatu EE, Guzman DM, Sweet AY. Serum C-reactive protein and problems of newborn infants. J Pediatr 1982;101:438-40.
13. Gonzalez BE, Mercado CK, Johnson L, Brodsky NL, Bhandari V. Early markers of late-onset sepsis in prema- ture neonates: clinical, hematological and cytokine profile. J Perinat Med 2003;31:60-8.
14. Ang AT, Ho NK, Chia SE. The usefulness of CRP and I/T ratio in early diagnosis of infections in Asian newborns J Singapore Paediatr Soc 1990;32:159-63.