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Vol. 59. Núm. 3.
Páginas 246-251 (Septiembre 2003)
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Vol. 59. Núm. 3.
Páginas 246-251 (Septiembre 2003)
Acceso a texto completo
Interleucina-6 y factor de necrosis tumoral-α como marcadores de infección neonatal de transmisión vertical
Interleukin-6 And Tumor Necrosis Factor-A As Markers Of Vertically-Transmitted Neonatal Bacterial Infection
Visitas
10707
S. Rite Graciaa, J.M. Grasa Ullrichb, C. Ruiz de la Cuesta Martína, J.M. Grasa Biecb, V. Rebage Moisésa, A. Marco Telloa, S. Rite Montañés
,a
a Unidad Neonatal. Servicio de Pediatría. Hospital Universitario Materno-Infantil Miguel Servet
b Unidad Analítica de Referencia Dr. J.M. Grasa Biec. Zaragoza. España
Este artículo ha recibido
Información del artículo
Introducción

La infección neonatal es una importante causa de morbilidad en el período neonatal. Se han utilizado diferentes parámetros como marcadores de sepsis neonatal. La proteína C reactiva (PCR) ofrece una alta especificidad en las infecciones bacterianas pero su incremento no se observa hasta 12–24 h después de iniciarse la infección neonatal

Objetivo

Evaluar la utilidad de interleucina 6 (IL-6) y factor de necrosis tumoral alfa (TNF-α) en el diagnóstico precoz de la infección neonatal bacteriana de transmisión vertical

Material y métodos

Se incluyeron 34 recién nacidos ingresados en la unidad de cuidados intensivos neonatales con el diagnóstico inicial de dificultad respiratoria. En 12 recién nacidos se constató la existencia de criterios clínicos de sepsis o neumonía (grupo I); en 6 con hemocultivo positivo. Los restantes pacientes no cumplían criterios clínicos de infección (grupo II). Se determinaron a las 8,8 ± 7,3 h de vida niveles de IL-6, TNF-α, PCR e índice de (c/s). En 17 pacientes se determinaron los mismos parámetros a las 67,4 ± 24,8 h. Se utilizó test de Mann-Whitney en el análisis estadístico. Se determinó la sensibilidad y especificidad de los marcadores analizados

Resultados

No se encontraron diferencias significativas en las variables perinatales analizadas en ambos grupos. Al analizar los marcadores de infección encontramos diferencias significativas en: índice de c/s: (0,25 ± 0,21 frente a 0,12 ± 0,09; p=0,048), PCR primer control: 1,4 ± 0,8mg/dl frente a 1 ± 0,5mg/dl; p=0,036; segundo control: 3,8 ± 1,8mg/dl frente a 1,4 ± 1,1mg/dl; p=0,008; IL-6 primer control: 582,2 ± 810,5pg/ml frente a 31,3 ± 24,2pg/ml; p=0,000. Sensibilidad/especificidad (%): índice c/s: 41,6/83,6; PCR primer control: 16,6/90,9; PCR segundo control: 83,3/87,5; IL-6 (punto de corte óptimo: 55pg/ml): 100/72,7 y TNF-α: 16,6/85

Conclusiones

La determinación en las primeras horas de vida de IL-6 contribuye de una forma más rápida al diagnóstico de infección neonatal que otros marcadores clásicos, debido a su elevación precoz. La determinación precoz de TNF-α ha mostrado, al igual que la PCR, una alta especificidad pero con escasa sensibilidad

Palabras clave:
Sepsis
Interleucina-6
Factor de necrosis tumoral alfa
Proteína C reactiva
Introduction

Neonatal infection is a major cause of morbidity in the neonatal period. Several parameters have been used to assess neonatal sepsis. C-reactive protein (CRP) shows high specificity for bacterial infections, but an increase in CRP is often not detected until 12 to 24 hours after onset of the infection

Objective

To evaluate the usefulness of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the early diagnosis of vertically-transmitted neonatal bacterial infection

Methods

Thirty-four newborns admitted to the neonatal intensive care unit with an initial diagnosis of respiratory distress were included. Twelve newborns presented the criteria for clinical sepsis or pneumonia (group I) and six had positive blood culture. The remaining patients did not present the clinical criteria for infection (group II). IL-6, TNF-α, CRP levels and the ratio between immature and mature neutrophil count were assessed at 8.8 ± 7.3 hours of life. In 17 patients the same parameters were assessed at 67.4 ± 24.8 hours of life. The statistical analysis was performed using the Mann-Whitney test. The sensitivity and specificity of these markers were assessed

Results

No differences were found in the perinatal features of either group. Analysis of markers of infection revealed the following significant differences: ratio between immature and mature neutrophil count: (0.25 ± 0.21 vs 0.12 ± 0.09; p=0.048), CRP first determination (1.4 ± 0.8mg/dL vs 1 ± 0.5mg/dL; p=0.036), CRP second determination: (3.8 ± 1.8mg/dL vs 1.4 ± 1.1mg/dL; p=0.008), IL-6 first determination: (582.2 ± 810.5pg/mL vs 31.3 ± 24.2pg/mL; p=0.000). Sensitivity/specificity (%): ratio between immature and mature neutrophil count: 41.6/83.6; CRP first determination: 16.6/90.9; CRP second determination: 83.3/87.5; IL-6 (optimum cut-off value: 55pg/mL): 100/72.7, and TNF-α: 16.6/85

Conclusions

IL-6 determination in the first hours of life is a more sensitive early marker of neonatal infection than other classical markers because of its early elevation. Like CRP, early TNF-α determination has high specificity but low sensitivity

Key words:
Sepsis
Interleukin-6
Tumor necrosis factor-α
C-reactive protein
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