Download PDF
Am J Perinatol 2001; 18(6): 313-324
DOI: 10.1055/s-2001-17857
ORIGINAL ARTICLES

Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Interleukin-6 and Interleukin-8 in Newborn Bacterial Infection

Sam S. Mehr1 2 , Lex W. Doyle1 2 3 , Greg E. Rice2 , Peter Vervaart4 , Philip Henschke1
  • 1Division of Newborn Services, The Royal Women's Hospital, Carlton, Australia
  • 2Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Australia
  • 3Department of Paediatrics, The University of Melbourne, Parkville, Australia; and the
  • 4Department of Clinical Biochemistry, Women's and Children's Health Care Network, Parkville, Australia
Further Information

Publication History

Publication Date:
17 October 2001 (online)

    Permissions and Reprints

ABSTRACT

The objective of this study is to determine the plasma concentrations and diagnostic accuracy of interleukin-6 (IL-6) and interleukin-8 (IL-8) in newborn infection. One hundred and one newborn infants with clinical signs of infection during their primary hospitalization were investigated with the minimum of a blood culture, C-reactive protein (CRP), full blood examination (FBE), and cytokine concentrations (IL-6 and IL-8). Infection in infants was classified without knowledge of cytokine levels into four groups-definite (n = 11), probable (n = 12), uncertain (n = 52), and nil (n = 26). The median concentrations of IL-6 and IL-8 were significantly higher in the definitely infected group compared with the other three groups (p <0.05). At the cut-off concentration of highest accuracy, IL-6 (>175 pg/mL) and IL-8 (>28 pg/mL) had similar sensitivities (80 and 82%, respectively) and specificities (91 and 81%, respectively). Cut-off concentrations could be identified with improved sensitivities (90% for IL-6 and 100% for IL-8) that maintained specificity >50%. However, the confidence intervals were wide for all sensitivities and specificities. IL-6 and IL-8 had little diagnostic accuracy in infants with probable infection. IL-6 and IL-8 concentrations increase early in newborn infants with definite infection.

KEYWORD

Newborn - sepsis - cytokines

REFERENCES

  • 1 Isaacs D, Barfield C P, Grimwood K. Systemic bacterial and fungal infections in infants in Australian neonatal units.  Med J Aust . 1995;  162 198-201
    PubMedGoogle Scholar
  • 2 Stoll B J, Gordon T, Korones S B. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network.  J Pediatr . 1996;  129 63-71
    PubMedGoogle Scholar
  • 3 Baltimore R S. Neonatal nosocomial infections.  Semin Perinatol . 1998;  22 25-32
    CrossrefPubMedGoogle Scholar
  • 4 Payne N R, Schilling C G, Steinberg S. Selecting antibiotics for nosocomial bacterial infections in patients requiring neonatal intensive care.  Neonatal Network . 1994;  13 41-51
    PubMedGoogle Scholar
  • 5 Hammerschlag M R, Klein J O, Herschel M. Patterns of use of antibiotics in two newborn nurseries.  New Engl J Med . 1977;  295 1268-1269
    PubMedGoogle Scholar
  • 6 Gerdes J S. Clinicopathologic approach to the diagnosis of neonatal sepsis.  Clin Perinatol . 1991;  18 361-381
    PubMedGoogle Scholar
  • 7 Mehr S, Doyle L W. Cytokines as markers of bacterial infection in newborn infants: a review.  Pediatr Infect Dis J . 2000;  19 879-887
    PubMedGoogle Scholar
  • 8 Gudmundsson A, Ershler W B, Goodman B. Serum concentrations of interleukin-6 are increased when sampled through an indwelling venous catheter.  Clin Chem . 1997;  43 2199-2201
    PubMedGoogle Scholar
  • 9 Swischuk L E. Imaging of the Newborn and Young Child.  3rd ed. Baltimore: Williams and Wilkins 1989: 59-63
    Google Scholar
  • 10 Kanto W P, Hunter J E, Stoll B J. Recognition and medical management of necrotizing enterocolitis.  Clin Perinatol . 1994;  21 335-346
    PubMedGoogle Scholar
  • 11 Manroe B L, Weinberg A G, Rosenfeld C R. The neonatal blood count in health and disease I: reference values for neutrophilic cells.  J Pediatr . 1979;  95 89-98
    CrossrefPubMedGoogle Scholar
  • 12 SPSS for Windows (computer program), version 9.0.1. Chicago: SPSS, Inc.; 1999
  • 13 Fowlie P W, Schmidt B. Diagnostic tests for bacterial infection from birth to 90 days: a systematic review.  Arch Dis Child Fetal Neonatal Ed . 1998;  78 F92-F98
    CrossrefPubMedGoogle Scholar
  • 14 Edgar J DM, Wilson D C, McMillan S A. Predictive value of soluble immunological mediators in neonatal infection.  Clin Sci . 1994;  87 165-171
    PubMedGoogle Scholar
  • 15 Buck C, Bundschu J, Gallati H. Interleukin-6: a sensitive parameter for the early diagnosis of neonatal bacterial infection.  Pediatrics . 1994;  93 54-58
    PubMedGoogle Scholar
  • 16 de Bont S E, Martens A, van Raan J. Diagnostic value of plasma levels of tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) in newborns with sepsis.  Acta Paediatr . 1994;  83 696-699
    PubMedGoogle Scholar
  • 17 Ng P C, Cheng S H, Chui K M. Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants.  Arch Dis Child . 1997;  77 F221-F227
    PubMedGoogle Scholar
  • 18 Panero A, Pacificio L, Rossi N. Interleukin 6 in neonates with early and late onset infection.  Pediatr Infect Dis J . 1997;  16 370-375
    CrossrefPubMedGoogle Scholar
  • 19 Doellner H, Arntzen K J, Haereid P E. Interleukin-6 concentrations in neonates evaluated for sepsis.  J Pediatr . 1998;  132 295-299
    CrossrefPubMedGoogle Scholar
  • 20 Küster H, Weiss M, Willeitner A E. Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation.  Lancet . 1998;  352 1271-1277
    CrossrefPubMedGoogle Scholar
  • 21 Silveira R C, Procianoy R S. Evaluation of interleukin-6, tumour necrosis factor-alpha and interleukin-1 beta for early diagnosis of neonatal sepsis [see comments].  Acta Pediatr . 1999;  88 647-650
    CrossrefPubMedGoogle Scholar
  • 22 Franz A R, Kron M, Pohlandt F, Steinbach G. Comparison of procalcitonin with interleukin 8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in newborn infants.  Pediatr Infect Dis J . 1999;  18 666-671
    CrossrefPubMedGoogle Scholar
  • 23 Franz A R, Steinbach G, Kron M, Pohlandt F. Reduction of unnecessary antibiotic therapy in newborn infants using interleukin-8 and C-reactive protein as markers of bacterial infections.  Pediatrics . 1999;  104 447-453
    CrossrefPubMedGoogle Scholar
  • 24 Messer J, Eyer D, Donato L. Evaluation of interleukin-6 and soluble receptors of tumour necrosis factor for early diagnosis of neonatal infection.  J Pediatr . 1996;  129 574-580
    CrossrefPubMedGoogle Scholar
  • 25 Kallman J, Ekholm L, Eriksson M, Malmstrom B, Schollin J. Contribution of interleukin-6 in distinguishing between mild respiratory disease and neonatal sepsis in the newborn infant.  Acta Paediatr . 1999;  88 880-884
    CrossrefPubMedGoogle Scholar
  • 26 Lehrnbecher T, Schrod L, Rutsch P. Immunologic parameters in cord blood indicating early onset sepsis.  Biol Neonate . 1996;  70 206-212
    PubMedGoogle Scholar
  • 27 Lehrnbecher T, Schrod L, Kraus D. Interleukin-6 and soluble interleukin-6 receptor in cord blood in the diagnosis of early onset sepsis in neonates.  Acta Paediatr . 1995;  84 806-808
    PubMedGoogle Scholar
  • 28 Beck-Sague C M, Azimi P, Fonseca S. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study.  Pediatr Infect Dis J . 1994;  13 1110-1116
    PubMedGoogle Scholar
  • 29 Önal E E, Kitapci F, Dilmen U. Interleukin-6 concentration in neonatal sepsis.  Lancet . 1999;  353 239-240
    PubMedGoogle Scholar
  • 30 Philip A GS, Hewitt J R. Early diagnosis of neonatal sepsis.  Pediatrics . 1980;  65 1036-1041
    PubMedGoogle Scholar
  • 31 Philip A GS. Detection of neonatal sepsis of late onset.  JAMA . 1982;  247 489-492
    CrossrefPubMedGoogle Scholar
  • 32 Chan D KL, Ho L Y. Usefulness of C-reactive protein in the diagnosis of neonatal sepsis.  Singapore Med J . 1997;  38 252-255
    PubMedGoogle Scholar
  • 33 Benitz W E, Han M Y, Madan A. Serial serum C-reactive protein levels in the diagnosis of neonatal infection.  Pediatrics . 1998;  102 E41
    CrossrefPubMedGoogle Scholar
  • 34 Mehr S, Doyle L. Interleukin-6 concentrations in neonatal sepsis.  Lancet . 1999;  353 1798-1799
    PubMedGoogle Scholar
  • 35 Gilbert L, James G, Sitchenko V. Culture shock: molecular methods for diagnosis of infectious diseases.  Med J Aust . 1999;  171 536-539
    PubMedGoogle Scholar
      >