Objective: To compare the diagnostic accuracy of neutrophil and monocyte CD64 indexes (CD64in and CD64im) for sepsis in critically ill neonates and childrenwith that of lipopolysaccharide-binding protein (LBP), procalcitonin (PCT) and C-reactive protein (CRP). Design and setting: Prospective, observational study in a level III multidisciplinary neonatal and pediatric intensive care unit (ICU). Patients: Forty-six neonates and 36 children with systemic inflammatory response syndrome (SIRS) and suspected infection, classified into two groups: those with bacterial sepsis (microbiologically proven or clinical sepsis) and those without bacterial sepsis (infection not supported by subsequent clinical course, laboratory data and microbiological tests). Interventions and Measurements: Flow cytometric CD64in and CD64im, serum LBP, PCT and CRP measurement on 2 consecutive days from admission to theICU. Results: There were 17 cases of bacterial sepsis in neonates and 24 cases of bacterial sepsis in children. All neonates and the majority of children were mechanically ventilated, and more than two-thirds of neonates with sepsis and one-third of children with sepsis needed inotropic/vasopressordrugs. The highest diagnostic accuracy for sepsis on the 1st day of suspected sepsis was achieved by LBP in neonates (0.86) and by CD64in in children (0.88) and 24 h later by CD64in in neonates (0.96) and children (0.98). Conclusions: Neutrophil CD64 index (CD64in) is the best individual marker for bacterial sepsis in children, while in neonates the highest diagnostic accuracy at the time of suspected sepsis was achieved by LBP and 24 h later by CD64in.
COBISS.SI-ID: 26058457
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 (POD0) 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 surgerywith 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 onPOD 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). Conclusion: 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 ofsurgery, very rapid and transient with relatively low concentrations. (Abs.trunc. at 2000 ch.)
COBISS.SI-ID: 27388377
Objective. To determine whether neutrophil defensins (HNP1-3) and interleukin-6 (IL-6) in vaginal fluid after preterm premature rupture of membranes predict fetal inflammatory response syndrome (FIRS), neurological impairment or chorioamnionitis. Design. Prospective study. Setting. Tertiary referral university hospital. Population. Forty-two patients with preterm premature rupture of membranes at (32 weeks. Methods. Levels of HNP1-3 and IL-6 were measured in vaginal fluid obtained by swabs. Mann-Whitney U-test wasused to compare HNP1-3 and IL-6 levels in groups with vs. without FIRS, infant death or neurological impairment, and chorioamnionitis (p(0.05 significant). Logistic regression was used to control for potential confounders. Diagnostic accuracies of HNP1-3 and IL-6 were determined by receiver operator characteristics analysis. Main Outcome Measures. Fetal inflammatory response syndrome was defined as neonatal inflammation within 72hours postpartum. Neurological impairment was defined as motor and/or tone abnormalities at one year of corrected age. Chorioamnionitis was diagnosed histologically. Results. Levels of HNP1-3, but not IL-6, were higher in 12 cases of FIRS (p=0.019 and p=0.256, respectively). Levels of HNP1-3, but not IL-6, were higher in 14 cases of infant death or neurological impairment (p=0.015 and p=0.100, respectively) and, when only survivors were analyzed, innine cases of neurological impairment (p=0.030 and p=0.187, respectively). Levels of HNP1-3 and IL-6 were higher in 29 cases of chorioamnionitis (p=0.005and p=0.003, respectively). The differences remained significant afteradjustment for gestational age. Levels of HNP1-3 predicted FIRS, infant death or neurological impairment and chorioamnionitis with an area under the curve of 0.75, 0.79 and 0.78, respectively. Conclusions. Elevated vaginal fluid HNP1-3 and IL-6 levels are associated with histological chorioamnionitis. (Abs. trunc. at 2000 ch.)
COBISS.SI-ID: 28563161