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PEDIATRICS Vol. 108 No. 4 October 2001, p. e61

ELECTRONIC ARTICLE:
Reactive Hyperemia and Interleukin 6, Interleukin 8, and Tumor Necrosis Factor-alpha in the Diagnosis of Early-Onset Neonatal Sepsis

Received Feb 1, 2001; accepted May 24, 2001.

Helena Martin*, Bodil OlanderDagger , and Mikael Norman*

From the * Department of Women and Child Health, Division of Neonatology, Karolinska Hospital; and Dagger  Department of Clinical Chemistry, Karolinska Laboratoriet, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.

Objective.  To evaluate the diagnostic value of peripheral circulatory reactive hyperemia and serum levels of interleukin-6 (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-alpha ) in early-onset neonatal sepsis.

Methods.  Reactive hyperemia in the dorsal hand and serum levels of IL-6, IL-8, and TNF-alpha were studied in newborn infants (n = 32; gestational age 39 ± 3 weeks) who had been admitted to the neonatal unit because of suspected sepsis <48 hours after birth. On admission, reactive hyperemia after a standardized arterial occlusion was measured with laser Doppler technique, and blood samples were taken for cytokine analyses. On the basis of predetermined criteria, the infants subsequently were classified as septic (n = 12) or not (n = 20).

Results.  The degree of reactive hyperemia was higher in the group with sepsis (median + 170% perfusion increase) than in that without (+37%). On admission, serum levels of IL-6, IL-8, and TNF-alpha all were higher in septic (median values: 1620, 331, and 22 pg/mL, respectively) than in nonseptic neonates (median values: 42, 63, and 13 pg/mL, respectively). In the group with sepsis, the degree of reactive hyperemia correlated to log IL-6 (r = 0.80) and log IL-8 values (r = 0.71).

Conclusion.  Newborn infants with septicemia have increased reactive hyperemia and elevated cytokine levels very early in their disease. Reactive hyperemia in skin can be analyzed at the bedside and noninvasively and therefore may serve as an additional diagnostic tool in neonatal sepsis.  Key words:  neonatal sepsis, newborn infant, interleukin-6, interleukin-8, TNF-alpha , reactive hyperemia, diagnostic marker.