Información de la revista
Vol. 59. Núm. 3.
Páginas 246-251 (Septiembre 2003)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 59. Núm. 3.
Páginas 246-251 (Septiembre 2003)
DOI: 10.1016/S1695-4033(03)78174-0
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
...
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
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
El Texto completo está disponible en PDF
Bibliografía
[1.]
H. Kuster, M. Weiss, A. Willeitner, S. Detlefsen, I. Jeremias, J. Zbojan, et al.
Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation.
Lancet, 352 (1998), pp. 1271-1277
[2.]
R. Silveira, R.S. Procianoy.
Evaluation of interleukin-6, tumour necrosis factor-α and interlukin-1β for early diagnosis of neonatal sepsis.
Acta Paediatr, 88 (1999), pp. 647-650
[3.]
J. Källman, L. Ekholm, M. Eriksson, B. Malmström, Schollin.
Contribution of interleukin-6 in distinguishing between mild respiratory disease and neonatal sepsis in the newborn infant.
Acta Pediatr, 88 (1999), pp. 880-884
[4.]
H. Doellner, K. Arntzen, E. Haereid, S. Aag, R. Austgulen.
Interleukin- 6 concentrations in neonates evaluated for sepsis.
J Pediatr, 132 (1998), pp. 295-299
[5.]
J.M. Grasa Ullrich, S. Rite Gracia, J.M. Grasa Biec, A. Marco Tello, S. Rite Montañés.
Valores de referencia de interleucina 6 (IL-6) y factor de necrosis tumoral alfa (TNF-α) en recién nacidos sanos.
An Esp Pediatr, 54 (2001), pp. 526-527
[6.]
A.G.S. Philip, J.R. Hewith.
Early diagnosis of neonatal sepsis.
Pediatrics, 65 (1980), pp. 1036-1041
[7.]
J.O. Klein, S.M. Marcy.
Bacterial sepsis and meningitis.
Infectious diseases of the fetus and newborn infant, pp. 835-878
[8.]
M. Kantar, N. Kültürsay, N. Kütükcüler, M. Akisü, N. cetingül, S. Caglayan.
Plasma concentrations of granulocyte-macrophage colony-stimulating factor and interleukin-6 in septic and healthy preterms.
Eur J Pediatr, 159 (2000), pp. 156-157
[9.]
H. Martin, B. Olander, M. Norman.
Reactive hyperemia and interleukin- 6, interleukin-8 and tumor necrosis factor-α in the diagnosis of early-onset neonatal sepsis.
Pediatrics, 108 (2001), pp. E61
[10.]
M. Jokic, B. Guillois, B. Cauquelin, J.D. Giroux, J.L. Bessis, R. Morello, et al.
Fetal distress increases interleukin-6 and interleukin- 8 and decreases tumour necrosis factor-α cord blood levels in noninfected full-term neonates.
Br J Obstet Gynaecol, 107 (2000), pp. 420-425
[11.]
A.R. Franz, M. Kron, F. Pohlandt, G. Steinbach.
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, 18 (1999), pp. 666-671
[12.]
F. Maire, M.C. Héraud, Y. Loriette, B. Normand, R.J. Begue, A. Labbé.
Intéret de la procalcitonine dans les infections néonatales.
Arch Pediatr, 6 (1999), pp. 503-509
[13.]
C. Sachse, F. Dressler, E. Henkel.
Increased serum procalcitonin in newborn infants without infection.
Clin Chem, 44 (1998), pp. 1343-1344
[14.]
T. Martin-Denavit, G. Monneret, J.M. Labaune, C. Isaac, F. Bienvenu, G. Putet, et al.
Usefulness of procalcitonin in neonates at risk for infection.
Clin Chem, 45 (1999), pp. 440-441
[15.]
C. Chiesa, A. Panero, N. Rossi, M. Stegagno, M. De Guiusti, J.F. Osborn, et al.
Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates.
Clin Infect Dis, 26 (1998), pp. 664-672
[16.]
A. Lapillonne, E. Basson, G. Monneret, J. Bienvenu, B.L. Salle.
Lack of specificity of procalcitonin for sepsis diagnosis in premature infants.
Lancet, 351 (1998), pp. 1211-1212
[17.]
G. Monneret, J.M. Labaune, C. Isaac, F. Bienvenu, G. Putet, J. Bienvenu.
Increased serum procalcitonin levels are not specific to sepsis in neonates.
Clin Infect Dis, 27 (1998), pp. 1559-1561
[18.]
A.G. Lacour, A. Gervaix, S.A. Zamora, L. Vadas, P.R. Lombard, J.M. Dayer, et al.
Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive protein as identificators of serious bacterial infections in children with fever without localising signs.
Eur J Pediatr, 160 (2001), pp. 95-100
[19.]
J.C. Smulian, A.M. Vintzileos, Y.L. Lai, J. Santiago, S. Shen-Schwarz, W.A. Campbell.
Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis.
[20.]
U. Büscher, F.C.K. Chen, A. Pitzen, R. Menon, M. Voget, M. Obladen, et al.
IL-1β, IL-6, IL-8 and G-CSF in the diagnosis of earlyonset neonatal infections.
J Perinat Med, 28 (2000), pp. 383-388
[21.]
F. Kashlan, J. Smulian, S. Shen-Schwarz, M. Anwar, M. Hiatt, T. Hegyi.
Umbilical vein interleukin-6 and tumor necrosis factor alpha plasma concentrations in the very preterm infant.
Pediatr Infect Dis J, 19 (2000), pp. 238-243
[22.]
M. Krueger, M.S. Nauck, S. Sang, R. Hentschel, H. Wieland, R. Berner.
Cord blood levels of interleukin-6 and interleukin-8 for the immediate diagnosis of early-onset infection in premature infants.
Biol Neonate, 80 (2001), pp. 118-123
[23.]
H. Dollner, L. Vatten, I. Linnebo, G.F. Zanussi, A. Laerdal, R. Austgulen.
Inflammatory mediators in umbilical plasma from neonates who develop early-onset sepsis.
Biol Neonate, 80 (2001), pp. 41-47
[24.]
C. Santana, M.C. Guindeo, G. González, F. García-Muñoz, P. Saavedra, E. Doménech.
Cord Blood levels of cytokines as predictors of early neonatal sepsis.
Acta Paediatr, 90 (2001), pp. 1176-1181
[25.]
E. Weiman, S. Rutkowski, G. Reisbach.
G-CSF, GM-CSF and IL-6 levels in cord blood: Diminished increase of G-CSF and IL-6 in preterm with perinatal infection compared to term neonates.
J Perinat Med, 26 (1998), pp. 211-218
Copyright © 2003. Asociación Española de Pediatría
Idiomas
Anales de Pediatría

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?