Laboratory aid to the diagnosis and therapy of infection in the neonate

Gaetano Chirico, Cristina Loda, Gaetano Chirico, Cristina Loda

Abstract

Despite the advances in perinatal and neonatal care and use of newer potent antibiotics, the incidence of neonatal sepsis remains high and the outcome is still severe. For years, investigators have sought a test or panel of tests able to identify septic neonates accurately and rapidly in order to obtain an early diagnosis and develop a specific effective treatment for a successful outcome. In addition to the standard procedures (blood, CSF, and urine cultures), such panels have included a combination of haematological investigations (total, differential and immature cell counts), and levels of acute-phase reactants (principally CRP and procalcitonin), and cytokines (such as IL-6 or neutrophil CD64). Furthermore, the science of proteomics and genomics has been applied to the search for bio-markers, production of protein profiles and genetic polymorphisms that can rapidly help the prediction, early diagnosis, and treatment of human diseases, but, for now, data are as yet insufficient to confirm their validity.

Keywords: IgG antibodies.; neonatal sepsis.

Figures

Figure 1
Figure 1
Inflammatory reaction during sepsis.

References

    1. Chirico G, Cortinovis S, Fonte C, Giudici G. Bacterial sepsis. J Chemother. 2007;19:28–30.
    1. Chirico G. Development of the Immune System in Neonates. J Arab Neonatal Forum. 2005;2:5–11.
    1. Lewis DB, Tu W. The physiologic immunodeficiency of immaturity. In Immunologic disorders in infants and children. In: Stiehm ER, Ochs HD, Winkelstein JA, editors. fifth Edition. Philadelphia: Elsevier Saunders Company; 2004.
    1. Chirico G, Marzollo R, Cortinovis S, et al. Antiinfective properties of human milk. J Nutr. 2008;138:1801S–1806S.
    1. Russell JA. Management of Sepsis. N Engl J Med. 2006;355:1699–713.
    1. Stoll BJ, Hansen NI, Adams-Chapman I, et al. Neurodevelopmental and Growth Impairment Among Extremely Low-Birth-Weight Infants With Neonatal Infection. JAMA. 2004;292:2357–2365.
    1. Hermansen MC, Hermansen MG. Perinatal Infections and Cerebral Palsy. Clin Perinatol. 2006;33:315–33.
    1. Dammann O, Leviton A. Inflammation, brain damage and visual dysfunction in preterm infants. Semin Fetal Neonatal Med. 2006;11:363–8.
    1. La Pine TR, Hill HR. Host defense mechanisms against bacteria. In: Polin RA, Fox WW, Abman SH, editors. Fetal and Neonatal Physiology. 3th ed. Philadelphia: Saunders; 2004. pp. 1475–1486.
    1. Schelonka RL, Chai MK, Yoder BA, et al. Volume of blood required to detect common neonatal pathogens. J Pediatr. 1996;129:275–8.
    1. Mishra UK, Jacobs SE, Doyle LW, Garland SM. Newer approaches to the diagnosis of early onset neonatal sepsis. Arch Dis Child Fetal Neonatal Ed. 2006;91:208–212.
    1. Weinberg GA, D’Angio CT. Laboratory Aids for Diagnosis of Neonatal Sepsis. In: Remington JS, Klein JO, editors. Infectious Diseases of the Fetus and Newborn Infant. Sixth ed. Philadelphia: W.B. Saunders Company; 2006. pp. 1207–1222.
    1. Deeks JJ. Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001;323:157–62.
    1. Benitz WE. Adjunct laboratory tests in the diagnosis of early-onset neonatal sepsis. Clin Perinatol. 2010;37:421–38.
    1. Da Silva O, Ohlsson A, Kenyon C. Accuracy of leukocyte indices and C-reactive protein for diagnosis of neonatal sepsis: a critical review. Pediatr Infect Dis J. 1995;14:362–6.
    1. Hatherill M, Tibby SM, Sykes K, et al. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count. Arch Dis Child. 1999;81:417–21.
    1. Chirico G, Gasparoni A, Ciardelli L, et al. Leukocyte counts in relation to the method of delivery during the first five days of life. Biol Neonate. 1999;75:294–9.
    1. Mussap M, Degrandi R, Cataldi L, et al. Biochemical markers for the early assessment of neonatal sepsis: the role of procalcitonin. J Chemother. 2007;19:35–8.
    1. Assumma M, Signore F, Pacifico L, et al. Serum procalcitonin concentrations in term delivering mothers and their healthy offspring: a longitudinal study. Clin Chem. 2000;46:1583–7.
    1. Chiesa C, Signore F, Assumma M, et al. Serial measurements of C-reactive protein and interleukin-6 in the immediate postnatal period: reference intervals and analysis of maternal and perinatal confounders. Clin Chem. 2001;47:1016–22.
    1. Lapillonne A, Basson E, Monneret G, et al. Lack of specificity of procalcitonin for sepsis diagnosis in premature infants. Lancet. 1998;351:1211–2.
    1. Yu Z, Liu J, Sun Q, et al. The accuracy of the procalcitonin test for the diagnosis of neonatal sepsis: a meta-analysis. Scand J Infect Dis. 2010;42:723–33.
    1. Chirico G, Motta M, Villani P, et al. Late-onset neutropenia in very low birthweight infants. Acta Paediatr Suppl. 2002;91:104–8.
    1. Fowlie PW, Schmidt B. Diagnostic tests for bacterial infection from birth to 90 days a systematic review. Arch Dis Child. 1998;78:F92–F98.
    1. Berner R, Niemeyer CM, Leititis JU, Funke A, Schwab C, Rau U, Richter K, Tawfeek MS, Clad A, Brandis M. Plasma levels and gene expression of granulocyte colony-stimulating factor, tumor necrosis factor-alpha, inter-leukin (IL)-1beta, IL-6, IL-8, and soluble intercellular adhesion molecule-1 in neonatal early onset sepsis. Pediatr Res. 1998;44:469–77.
    1. Buscher U, Chen FC, Pitzen A, Menon R, Vogel M, Obladen M, Dudenhausen JW. Il-1 beta, Il-6, Il-8 and G-CSF in the diagnosis of early-onset neonatal infections. J Perinat Med. 2000;28:383–8.
    1. Ng PC, Lam HS. Biomarkers for late-onset neonatal sepsis: cytokines and beyond. Clin Perinatol. 2010;37:599–610.
    1. Kantar M, Kultursay N, Kutukculer N, Akisu M, Cetingul N, Caglayan S. Plasma concentrations of granulocyte-macrophage colony-stimulating factor and interleukin-6 in septic and healthy preterms. Eur J Pediatr. 2000;159:156–7.
    1. Chirico G, Ciardelli L, Cecchi P, De Amici M, Gasparoni A, Rondini G. Serum concentration of granulocyte colony stimulating factor in term and preterm infants. Eur J Pediatr. 1997;156:269–71.
    1. Krueger M, Nauck MS, Sang S, Hentschel R, Wieland H, Berner R. Cord blood levels of interleukin-6 and interleukin-8 for the immediate diagnosis of early-onset infection in premature infants. Biol Neonate. 2001;80:118–23.
    1. Romagnoli C, Frezza S, Cingolani A, De Luca A, Puopolo M, De Carolis MP, Vento G, Antinori A, Tortorolo G. Plasma levels of interleukin-6 and interleukin-10 in preterm neonates evaluated for sepsis. Eur J Pediatr. 2001;160:345–50.
    1. Bhandari V, Wang C, Rinder C, Rinder H. Hematologic profile of sepsis in neonates: neutrophil CD64 as a diagnostic marker. Pediatrics. 2008;121:129–34.
    1. Küster H, Weiss M, Willeitner AE, Detlefsen S, Jeremias I, Zbojan J, Geiger R, Lipowsky G, Simbruner G. Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation. Lancet. 1998;352:1271–7.
    1. Buhimschi IA, Buhimschi CS. The role of proteomics in the diagnosis of chorioamnionitis and early-onset neonatal sepsis. Clin Perinatol. 2010;37:355–74.
    1. Jordan JA, Durso MB, Butchko AR, Jones JG, Brozanski BS. Evaluating the near-term infant for early onset sepsis: progress and challenges to consider with 16S rDNA polymerase chain reaction testing. J Mol Diagn. 2006;8:357–63.
    1. Reier-Nilsen T, Farstad T, Nakstad B, Lauvrak V, Steinbakk M. Comparison of broad range 16S rDNA PCR and conventional blood culture for diagnosis of sepsis in the newborn: a case control study. BMC Pediatr. 2009;9:5–5.
    1. Makhoul IR, Yacoub A, Smolkin T, Sujov P, Kassis I, Sprecher H. Values of C-reactive protein, procalcitonin, and Staphylococcus-specific PCR in neonatal late-onset sepsis. Acta Paediatr. 2006;95:1218–23.
    1. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases. Prevention of Perinatal Group B Streptococcal Disease - Revised Guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59((RR-10)):1–36.
    1. Atkins KL, Atkinson RM, Shanks A, et al. Evaluation of polymerase chain reaction for group B streptococcus detection using a improved culture method. Obstet Gynecol. 2006;108:488–91.
    1. Kwiatkowski D. Science, medicine, and the future: susceptibility to infection. BMJ. 2000;321:1061–5.
    1. Schroder J, Kahlke V, Book M, Stuber F. Gender differences in sepsis: genetically determined? Shock. 2000;14:307–10.
    1. Fleer A, Krediet TG. Innate immunity: toll-like receptors and some more. A brief history, basic organization and relevance for the human newborn. Neonatology. 2007;92:145–57.
    1. Misch EA, Hawn TR. Toll-like receptor polymorphisms and susceptibility to human disease. Clin Sci (Lond) 2008;114:347–60.
    1. Del Vecchio A, Ladisa G, Laforgia N, De Felice C, Presta G, Latini G. Genetic polymorphisms in neonatal sepsis. Haematologica Reports. 2006;2:31–37. (available at )
    1. Schueller AC, Heep A, Kattner E, Kroll M, Wisbauer M, Sander J, Bartmann P, Stuber F. Prevalence of Two Tumor Necrosis Factor Gene Polymorphisms in Premature Infants with Early Onset Sepsis. Biol Neonate. 2006;90:229–32.
    1. Levy O. Genetic screening for susceptibility to infection in the NICU setting. Pediatr Res. 2004;55:546–8.
    1. Michalek J, Svetlikova P, Fedora M, Klimovic M, Klapacova L, Bartosova D, Hrstkova H, Hubacek JA. Interleukin-6 gene variants and the risk of sepsis development in children. Hum Immunol. 2007;68:756–60.
    1. Chauhan M, McGuire W. Interleukin-6 (−174C) polymorphism and the risk of sepsis in very low birth weight infants: meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2008;93:F427–9.
    1. Henderson G, Craig S, Baier RJ, Helps N, Brocklehurst P, McGuire W. Cytokine gene polymorphisms in preterm infants with necrotising enterocolitis: genetic association study. Arch Dis Child Fetal Neonatal Ed. 2009;94:F124–8.
    1. Del Vecchio A, Laforgia N, Capasso M, Iolascon A, Latini G. The role of molecular genetics in the pathogenesis and diagnosis of neonatal sepsis. Clin Perinatol. 2004;31:53–67.
    1. Abdel-Hady H, El-Naggar M, El-Nady G, Badr R, El-Daker M. Genetic Polymorphisms of IL-6-174 and IL-10-1082 in Neonatal Blood Stream Infections. JPID. 2009;4:357–65.
    1. Chirico G, Chiappa S. Genetic polymorphisms and susceptibility to infection in neonates. JPID. 2009;4:317–20.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir