Study of interleukin-6 levels in early diagnosis of neonatal sepsis
Keywords:
Neonatal sepsis, Diagnostic markers, Mortality, IL-6 levelsAbstract
Background:Neonatal septicemia is one of the commonest causes of neonatal mortality and morbidity. Interleukin-6 Levels appears to be one of the most promising candidate cytokine for early diagnosis of neonatal septicaemia. The aim and objectives of this study was to study the role of IL-6 levels as an early marker for diagnosis of neonatal sepsis and to compare IL-6 levels with other septic markers.
Methods:This is a hospital based prospective study to evaluate the efficacy of IL-6 as an early diagnostic marker of neonatal sepsis. Eighty neonates, delivered in the hospital, having risk factors for neonatal sepsis, along with those coming to hospital with signs and symptoms of sepsis up to 28 days of life (as study group ) along with normal new-borns admitted to the postnatal ward without high risk factors (control group) were enrolled for this study.
Results:IL-6 Levels has shown maximum sensitivity of 95.83%, specificity of 87.50%, positive predictive value of 92%, negative predictive value of 93.33% and accuracy of 92.50 %. E. coli was the most common organism responsible for sepsis. CRP was reported to be highly sensitive (84.21%), and CBC was highly specific (75.00%), IT ratio has sensitivity of 62.5% and specificity of 56.25% while micro-ESR has shown sensitivity of 50.0% and specificity of 62.5%. Out of 80 cases, blood culture (BacTalert) showed growth in 48 cases in study group while two cases in control group. Thus blood culture positivity was 60%.
Conclusion:IL-6 test has maximum sensitivity as well as specificity in comparison with other septic markers. Blood culture is the gold standard for the diagnosis of septicemia. CRP is most sensitive while CBC is most specific marker in neonatal sepsis.
References
M. Jeeva Sankar, Ramesh Agarwal, Ashok K. Deorari, Vinod K. Paul. Sepsis in the new-born. In: M. Jeeva Sankar, Ramesh Agarwal, Ashok K. Deorari, Vinod K. Paul, eds. AIIMS - NICU Protocols. New Delhi: AIIMS; 2008: 3.
Siegel J, McCracken G. Sepsis Neonatarum. N Engl J Med. 1981;304(11):642-7.
Bhartiya D, Kapadia C, Sanghvi K, Singh H, Kelkar R, Merchant R. Preliminary studies on IL-6 levels in healthy and septic Indian neonates. Indian Pediatr. 2000;37:1361-7.
Saunders BM, Liu Z, Zhan Y, Cheers C. Interleukin-6 production during chronic experimental infection. Immunol Cell Biol. 1993;71:275-80.
Gupte S. Neonatal sepsis score system. In: Gupte S, eds. The Short Text Book of Pediatrics. 9th ed. New Delhi: Jaypee Brothers; 2001: 559-561.
Milenia Biotec. Interpretation guide for immune monitoring, 2011. Available at: http://anna-med.co.uk/Sepsis_Neonatal.pdf.
de Bont E, Martens A, van Raan J, Samson G, Fetter WP, Okken A, et al. Tumor necrosis factor-alpha, interleukin-1 beta and interleukin-6 plasma levels in neonatal sepsis. Pediatr Res. 1993;33:380-3.
Bhargav SK, Gupta A, Bhargav M. Bacterial Infections in new-born. Newer Devel Pediatr Res. 1977;1:11.
Mirf Amans, Khan SR. Neonatal sepsis: a review with study of 50 cases. J Trop Pediatr. 1987;33(3):131-5.
McCraken, Shinefield. Changes in the pattern of neonatal septicemia and meningitis. Am J Dis Child. 1966;112:33.
Faridi MMA, Gupta P, Bhargava SK. Chest radiograph in neonatal sepsis. Indian Pediatr. 1972;29:871.
Kumar GD, Ramachandran VG, Gupta P. Bacteriological analysis of blood culture isolates from neonate in tertiary care hospital in India. J Health Popul Nutr. 2002;20(4):343-7.
Chan DK, Ho LY. Usefulness of C-reactive protein in the diagnosis of neonatal sepsis. Singap Med J. 1997;38(6):252-5.
Franz AR, Steinbach G, Kron M, Pohlandt F. Reduction of unnecessary antibiotic therapy in new-born infants using interleukin-8 and C-reactive protein as markers of bacterial infections. Pediatrics. 1999;104:447-53.
Ghosh S, Mittal M, Jaganathan G. Early diagnosis of neonatal sepsis using a hematological scoring system. Indian J Med Sci. 2000;54(9):495-500.
Diwakar KK, Rosul G. Revised look at micro-erythrocyte sedimentation rate in neonates. Indian Pediatr. 1999;36:703-5.
Silveira RC, Procianoy RS. Evaluation of interleukin-6, tumour necrosis factor-a and interleukin-1 for early diagnosis of neonatal sepsis. Acta Pediatr. 1999;88:647-50.
Renato S. Procianoy, Rita C. Silveira. The role of sample collection timing on interleukin-6 levels in early-onset neonatal sepsis. J Pediatr (Rio J). 2004;80(5):407-10.
Milenia Biotec. Sepsis?, 2005. Available at: http://anna-med.co.uk/Sepsis_Neonatal.pdf.
