Diagnostic yield of at admission estimation of serum IL-6 and high-sensitivity CRP for Early-onset Neonatal Sepsis
1Hesham A. El-Ghaiaty, 2Ahmed F. El-Hassanin, 3Said M. Morsy, 4Lobna A. Mobasher
1Department of Pediatrics, Faculty of Medicine, Benha University, Egypt
2Department of Pediatrics, Faculty of Medicine, Mansoura University, Egypt
3Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
4Department of Clinical Pathology, Aladan Hospital, Kuwait
Abstract: Objectives: To evaluate the ability of at admission estimation of serum high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6 for discrimination between neonates had early-onset sepsis (EOS) and those free of infection and to act as early predictor for result of blood culture (BC).Patients & Methods: The study included 87 neonates admitted to neonatal ICU (NICU) underwent evaluation using the Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) with higher scores indicated more severe infection. Neonates were categorized into: Infected neonates had clinical manifestations of sepsis and positive BC, Clinically infected neonates had clinical manifestations of sepsis and negative BC and EOS-free neonates had negative BC and no clinical manifestations. Two venous blood samples were obtained: The first at time of NICU admission for ELISA estimation of hsCRP and IL-6 serum levels and the second sample was obtained either at time of development of clinical signs of sepsis or at of 72 hours in non-infected groups was used for BC and for complete blood count. Results: Blood culture was positive in 43 neonates (Infected), 19 neonates were clinically infected and 25 neonates were EOS-free. Mean SNAPPE II score and serum hs-CRP levels were significantly lower in EOS-free neonates compared to infected neonates with non-significant difference between clinically infected neonates. Mean total WBC count and serum IL-6 levels were significantly lower in EOS-free compared to infected and in clinically infected compared to infected neonates. Regression analysis for studied parameters as predictors for sure neonatal EOS confirmed by positive BC defined high total WBC count and high serum IL-6 as the most significant predictors and as predictors for EOS among those had negative BC defined high total WBC count, high serum IL-6, elevated serum hsCRP and birth weight in decreasing order of significance. Conclusion: Combined at admission estimation of serum hsCRP and IL-6 levels in conjunction with at 72-hr WBC count could differentiate between infected and non-infected neonates and provide early prediction for positive BC so allowing early initiation of therapy for infected neonates.
[Hesham A. El-Ghaiaty, Ahmed F. El-Hassanin, Said M. Morsy, Lobna M. Mobasher. Diagnostic yield of at admission estimation of serum IL-6 and high-sensitivity CRP for Early-onset Neonatal SepsisJ Am Sci 2013;9(3):334-341]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 47
Kew words: Early-onset neonatal infection, interleukin-6, high-sensitivity CRP, Total leucocytic count.