Interleukin-6: A Sensitive Parameter for the Early Detection of Neonatal Sepsis

Background: Neonatal sepsis is a major cause of neonatal mortality and morbidity throughout the world. Though blood culture is the gold standard and has higher sensitivity and specificity over the hematological value and cytokine, it is not available in our community health situation and also in most of health care facilities. It is also time consuming. Therefore hematological value and interleukin-6 can be evaluated for the early diagnosis of neonatal bacterial infection. Objective: This study was conducted to see the usefulness of IL-6 as an early marker of neonatal sepsis and also to compare the sensitivity in comparison with CRP, hematological value and blood culture. Study Design: It was a quasy experimental study. Setting: This study was carried out in the neonatal unit of pediatric department, BSMMU during the period of September, 2005 to February, 2006. Method: Forty five suspected septic cases were enrolled in the study and thirty healthy newborn were taken for comparison. Venous blood sample from peripheral vein was collected on the 1st day of symptoms and/or 1st day of admission and was sent for IL-6 estimation within half an hour and estimation of IL-6 was done by using immunolyte DPC USA which employed automated chemiluminescent immunoassays. Results: Out of forty five cases of suspected-neonatal sepsis, IL-6 were positive in twenty five cases. In culture proven sepsis 100% cases had raised IL-6. In control group only five babies had raised IL-6. Three cases were culture positive, of which all were also positive for IL-6 (100%). Among the cases twenty six were CRP positive, of which twenty were also positive for IL-6 (76.92%). Conclusion: In the present study IL-6 was found to be an early marker of neonatal infection. Sensitivity was more than CRP and other hematological parameter in the first twenty four hours. Key words: Interleukin-6, Neonatal Sepsis.DOI: 10.3329/bsmmuj.v1i1.3687 BSMMU J 2008; 1(1): 1-5

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Comparative Study of Diagnostic Markers in Neonatal Sepsis

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v34i2.9788 ◽

2014 ◽

Vol 34 (2) ◽

pp. 111-114 ◽

Cited By ~ 1

Author(s):

Vijay Baburao Sonawane ◽

Sonali U Gaikwad ◽

Nitin N Kadam ◽

Jitendra Gavhane

Keyword(s):

Risk Factors ◽

Blood Culture ◽

Comparative Study ◽

Neonatal Sepsis ◽

Signs And Symptoms ◽

Diagnostic Markers ◽

Control Group ◽

Specific Marker ◽

Study Group ◽

Mortality And Morbidity

Introduction: Neonatal septicemia is one of the commonest causes of neonatal mortality and morbidity. The objectives of this study were intended for qualitative and quantitative analysis of diagnostic markers in neonatal sepsis.Materials and Methods: This is a hospital based study conducted over three years (Aug 2005 – Aug 2008). Hundred and sixty 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 newborns admitted to the postnatal ward without high risk factors (control group) were enrolled for this study. Comparative study on various diagnostics markers such blood culture, CBC,CRP, IT ratio and Micro-ESR was carried out to know their sensitivity and specificity.Results: 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 160 cases, blood culture (BacTalert) showed growth in48 cases in study group while two cases in control group. Thus blood culture positivity was 60%.Conclusion: Blood culture is the gold standard for the diagnosis of septicemia. CRP is most sensitive while CBC is most specific marker in neonatal sepsis.DOI: http://dx.doi.org/10.3126/jnps.v34i2.9788J Nepal Paediatr Soc 2014;34(2):111-114

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Serum Interleukin-33 as a Biomarker in Predicting Neonatal Sepsis in Premature Infants

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207321666180911090656 ◽

2018 ◽

Vol 21 (7) ◽

pp. 510-515 ◽

Cited By ~ 3

Author(s):

Halit Halil ◽

Cuneyt Tayman ◽

Mehmet Buyuktiryaki ◽

Nilufer Okur ◽

Ufuk Cakır ◽

...

Keyword(s):

Interleukin 6 ◽

Neonatal Sepsis ◽

Serum Levels ◽

Control Group ◽

Rapid Progression ◽

Study Group ◽

C Reactive Protein ◽

Mortality And Morbidity ◽

Interleukin 33 ◽

Reactive Protein

Background: Neonatal sepsis is considered as the most frequent cause of death in newborns. Early diagnosis is important to reduce mortality and morbidity. The rapid progression of the disease requires proper use of biomarkers specific for prompt diagnosis and intervention. Objective: We aimed to evaluate the benefit of interleukin-33 serum levels in the diagnosis and treatment of neonatal sepsis. Method: We included 51 infants with neonatal sepsis as the main study group and 50 neonates without sepsis as the control group. Serum levels of interleukin-6, interleukin-33 and C-reactive protein were measured on the 1st, 3rd and 7th days of sepsis in the study group and on the 3rd postpartum day in the control group, respectively. Results: Serum levels of interleukin-6, interleukin-33 and C-reactive protein were significantly higher in the first day of sepsis. Serum levels of interleukin-6, interleukin-33 and C-reactive protein decreased significantly on the 3rd and the 7th days of antibiotic treatment. We found a significant relationship between interleukin-33 and C-reactive protein and between interleukin-6 and C-reactive protein on the first day of sepsis. Conclusion: Serum interleukin-33 level is up-regulated in neonatal sepsis, which might be used as a novel diagnostic marker and also a useful tool to predict prognosis in early neonatal sepsis.

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Role of Serial C-reactive Protein (CRP) in Relation to Total Leucocyte Count, Platelet Count & Blood Culture for early Diagnosis of Neonatal Septicemia in Developing Countries

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v32i2.26032 ◽

2015 ◽

Vol 32 (2) ◽

pp. 61-65

Author(s):

Chiranjib Barua ◽

Md Nurul Anwar ◽

Md Shahidullah ◽

Shahadat Hossain ◽

Sharmila Barua ◽

...

Keyword(s):

Developing Countries ◽

Blood Culture ◽

Early Diagnosis ◽

Neonatal Sepsis ◽

Leucocyte Count ◽

Control Group ◽

Total Leucocyte Count ◽

C Reactive Protein ◽

Neonatal Septicemia ◽

Reactive Protein

Neonatal septicemia is a clinical syndrome of systemic illness accompanied by bacteremia occuring in the first 28 days of life. Neonatal septicemia is one of the major causes of neonatal death in developing countries. Early diagnosis and treatment can prevent neonatal mortality and morbidity. The present study includes: 1) usefulness of CRP (C-reactive protein), Total Leucocyte Count, Platelet Count and Blood Culture in early diagnosis of Neonatal Sepsis, 2) significance of serial CRP in diagnosis of neonatal sepsis. 3) the prognostic value of CRP in neonatal sepsis. This is a prospective study done in neonatal ward, Chittagong Medical College Hospital and carried out from January 2008 to January 2011. Sample size was 300. One hundred fifty neonates with suspected sepsis as cases and 150 healthy babies as control were enrolled in this study. Seventy two percent of cases neonates were preterm and low birth weight. Common risk factors for neonatal septicemia which were identified in this study; preterm (72%), low birth weight (72%), premature rupture membrane (60%), chorioamnionitis (26%) and maternal urinary tract infection (16%) . Out of 150 cases of suspected neonatal sepsis total 80.7%% had raised CRP, in initial sample 70.39% were CRP positive and in 2nd sample additional 9.31% case were CRP positive . In control group 91% were CRP negative. CRP was positive in 100% of culture proven sepsis. Sensitivity of CRP was 80.67% and specificity of CRP was 76.44%. Leucocytosis was observed in 7% of cases and leucopenia was found in 11% of cases. In 82 % cases leucocyte count was found normal. In control group, 95% had normal leucocyte count and 5% had leucocytosis but no leucopenia. Sensitivity of leucocyte count was 18% and specificity was 20.68%. Thrombocytopenia was found in 28% of case group. Out of 150 cases only 15.33% yielded growth of organisms in blood culture. Klebsiella was the most common pathogen isolated which was followed by E.coli and Strph. aureus. Sensitivity of blood culture was 15.33% and specificity was 100% Therefore serial CRP can be taken as alternative method for diagnosis of neonatal sepsis specially in developing countries where blood culture is not readily available.J Bangladesh Coll Phys Surg 2014; 32: 61-65

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CHARACTERIZATION AND ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF SEPTICAEMIA-CAUSING PATHOGENS ISOLATED FROM FEBRILE CHILDREN WITH SICKLE CELL DISEASE IN KANO, NIGERIA.

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2018.016 ◽

2018 ◽

Vol 10 (1) ◽

pp. e2018016 ◽

Cited By ~ 2

Author(s):

Ibrahim Yusuf

Keyword(s):

Sickle Cell Disease ◽

Blood Culture ◽

Sickle Cell ◽

Antimicrobial Susceptibility ◽

Venous Blood ◽

Salmonella Typhi ◽

Health Care Facilities ◽

Screening Methods ◽

Cell Disease ◽

Group B

Background and Objectives: Bacterial infection in sickle cell anaemic patients is a major cause of mortality and require proper treatment with appropriate antibiotics. However, continue defiant of these infections causing pathogens to many antibiotics and inadequate screening methods in overburden health care facilities such as our in Kano, Nigeria necessitates the conduct of this study. A research was therefore conducted on the characterizations and antimicrobial susceptibility of septicaemia-causing pathogens isolated from febrile children with sickle cell disease in Kano, Nigeria.Method: A total of 225 venous blood samples from suspected sickle cell anaemicchildren attending three selected hospitals within Kano metropolis were collected and screened for sickle cell disease, followed by blood culture using automated blood culture system (BD BACTEC) respectively. The bacteria isolated from confirmed SCD patients were characterized using microscopic, biochemical and serological techniques. Results: Results showed that of the 225 specimens collected,68 (30.22%) were SCD positive, with the highest percentage (16%) among subjects within 1-2 years of age. A total of 11 genera of bacteria were isolated from the SCD confirmed bloods, with Salmonella typhi having highest occurring rate 27 (39.71%), followed by Streptococcus pneumoniae10 (14.71%), Salmonella Group B 9(13.24%), Staphylococcus aureus 4 (5.88%),and Escherichia coli 3 (4.41%).Majority of the isolates 59 (86.76%) were highly susceptible to ciprofloxacin followed by cefuroxime 45 (66.18%), gentamicin 38 (55.88%), ceftriaxone 30 (44.12%), augmentin 39 (57.35%), ampicillin 25 (36.77%) and co-trimoxazole (22.06%). Conclusion: Septicaemia in SCD confirmed children in the three hospitals are caused by a combination of 11 genera of bacteria. Resistance to commonly used antibiotics are on increase, but treatment with ciprofloxacin is still promising.

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Prognostic Value of Ionized Calcium Levels in Neonatal Sepsis

Annals of Nutrition and Metabolism ◽

10.1159/000508685 ◽

2020 ◽

Vol 76 (3) ◽

pp. 193-200

Author(s):

Yalan Liu ◽

Yannan Chai ◽

Zhihui Rong ◽

Yan Chen

Keyword(s):

Organ Dysfunction ◽

Neonatal Sepsis ◽

Prognostic Value ◽

Characteristic Curve ◽

Univariate Analysis ◽

Neonatal Infection ◽

Ionized Calcium ◽

Control Group ◽

Serum Ionized Calcium ◽

Related Mortality

Background: Despite recent advances in the treatment of neonatal infection, mortality rates and comorbidities associated with neonatal sepsis remain high. Hypocalcemia has been reported in critically ill patients, especially in association with sepsis. However, the importance of hypocalcemia in neonatal sepsis has not been explored in detail. Objectives: The purpose of this study was to evaluate the prognostic value of hypocalcemia in neonatal sepsis patients and to identify the risk factors associated with sepsis-related mortality. Methods: This retrospective study examined perinatal data from patients in a level IV neonatal intensive care unit between January 2010 and June 2016. Univariate analysis was performed to understand the differences in clinical and laboratory characteristics between patients with and without neonatal sepsis. Neonates with sepsis were further stratified as having ionized hypocalcemia (if serum ionized calcium [iCa] <1.0 mmol/L) or not. Uni- and multivariate logistic regression analyses were utilized to evaluate the predictive potential of iCa for identifying sepsis-related mortality. Results: A total of 472 neonates were enrolled in this study, including 169 neonates diagnosed with culture-proven sepsis and 303 neonates without infection (control group). The comparison of neonates with and without sepsis highlighted significant differences in levels of iCa (0.97 ± 0.26 vs. 1.12 ± 0.25 mmol/L), magnesium (0.75 ± 0.22 vs. 0.89 ± 0.12 mmol/L), and phosphate (2.26 ± 1.08 vs. 1.65 ± 0.85 mmol/L; all p < 0.001). When neonates with sepsis were stratified into 2 subgroups based on serum iCa, neonates with hypocalcemia showed higher rates of organ dysfunction than those with normal iCa, as well as higher rates of cardiovascular system dysfunction (37.35 vs. 17.44%), renal dysfunction (34.94 vs. 30.95%), disseminated intravascular coagulation (26.51 vs. 11.63%), and seizure (16.04 vs. 5.8%; all p < 0.05). Among all neonates who had sepsis, the mortality rate was 13.61%, and this rate was higher among neonates with hypocalcemia than among those with normal iCa (20.48 vs. 6.98%, p < 0.05). Uni- and multivariate analyses showed that acidosis, hypoalbuminemia, hypocalcemia, and hyperphosphatemia were independent prognostic markers of sepsis-related mortality. In receiver-operating characteristic curve analysis, the areas under the curve were 0.70 (95% CI 0.624–0.768; p = 0.0004), 0.74 (95% CI 0.671–0.808; p < 0.0001), 0.73 (95% CI 0.653–0.792; p = 0.0002), and 0.67 (95% CI 0.59–0.737; p = 0.0154) for serum albumin, iCa, phosphate, and acidosis, respectively. Based on these findings, we developed a nomogram to predict sepsis-related mortality. Conclusions: Hypocalcemia is common in neonates with sepsis and is significantly associated with organ dysfunction and sepsis-related mortality.

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Statistical validity of interleukin-6 as a biomarker for the diagnosis of early-onset neonatal sepsis

Microbiology Research ◽

10.4081/mr.2012.e5 ◽

2012 ◽

Vol 3 (1) ◽

pp. 5 ◽

Cited By ~ 2

Author(s):

Sriparna Basu ◽

Shashikant Dewangan ◽

Shampa Anupurva ◽

Ashok Kumar

Keyword(s):

Risk Factors ◽

Blood Culture ◽

Cord Blood ◽

Interleukin 6 ◽

Neonatal Sepsis ◽

Early Onset ◽

Diagnostic Marker ◽

Statistical Validity ◽

Sepsis Screening ◽

Early Diagnostic

Use of empirical antibiotics in neonates with risk factors of early-onset neonatal sepsis (EOS) is a common practice. A laboratory parameter is needed to help in the accurate diagnosis of EOS to avoid unnecessary use of antibiotics. The aim of this prospective observational cohort study was to compare the statistical validity of cord blood interleukin-6 (IL-6) with conventional sepsis screening as an early diagnostic marker for EOS. Eighty-seven neonates with antenatal risk factors for sepsis were followed up for 72 h for the development of EOS. Cord blood was collected for measurement of IL-6 concentrations. Blood culture and conventional sepsis screening (total leukocyte count, absolute neutrophil count, C-reactive protein and micro-erythrocyte sedimentation rate) were sent for analysis soon after delivery. The study group comprised of symptomatic neonates with positive blood culture (n=36). An equal number of gestational-age matched asymptomatic neonates without risk factor of sepsis served as controls. Statistical validity of IL-6 was compared with sepsis screening parameters as the diagnostic marker for EOS. Gram negative organisms were the predominant cause of EOS. The most commonly isolated organism was Acinetobacter baumanii. The sensitivity and specificity of IL-6 with a cut-off value of 40.5 pg/mL and area under curve of 0.959 were 92.3 and 90.48%, respectively. In contrast, the sensitivity and specificity of different parameters of sepsis screening ranged from 37.5-68.75% and 47.95-57.35%, respectively. In conclusion, cord blood IL-6 can be used as a highly sensitive and specific early diagnostic marker of EOS at a cut-off concentration of 40.5 pg/mL.

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Raised IL-6 and C-reactive protein in neonatal sepsis in Eastern India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20173124 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1590

Author(s):

Kripasindhu Chatterjee ◽

Pradyut Kumar Mandal ◽

Sk. Rafikul Rahaman ◽

Ravela Malathi ◽

Swapan Kumar Ray ◽

...

Keyword(s):

Neonatal Sepsis ◽

Late Onset ◽

Venous Blood ◽

High Sensitivity ◽

Significant Rise ◽

Specific Marker ◽

Suspected Case ◽

High Positive Correlation ◽

Mortality And Morbidity ◽

Hs Crp

Background: Neonatal sepsis (NS) has significant morbidity and mortality rates and it is still difficult to diagnose on presentation. Early diagnosis and treatment decreases the mortality and morbidity of neonatal sepsis (NS). The study’s aim was to detect the levels of IL-6, CRP and hs-CRP in clinically suspected cases of neonatal sepsis and establish its association with the pathogenesis of the disease.Methods: The case control study consists of 70 neonates of whom 36 were clinically suspected case of sepsis admitted in NICU of paediatric department and were taken as cases and 34 were normal healthy neonates taken as control subjects. The cases as well as controls were within 28 days of age. Preterm and term neonates (<28 days of age) of both sexes showing signs of both early and late onset sepsis and also blood culture positive were included in the study. About 4 ml of venous blood was taken for measurement of hs CRP and IL 6. Serum hs-CRP levels was determined with a high-sensitivity nephelometric method while the serum level of IL 6 was measured by immunoassay Kits (Raybiotech, USA).Results: Serum IL 6 levels were increased in sepsis cases as compared to controls and were statistically significant (68.94±36.32 versus 8.26±3.82 pg/ml; P <0.0001). However, a high positive correlation was observed between ESR with serum IL 6 level (r=0.825; P = <0.001) among neonatal sepsis subjects while no correlation was seen in controls (r=0.279; P=0.098).Conclusions:It was observed that a significant rise in IL-6 or hs-CRP which may be suggested as specific marker for the identification of neonatal sepsis. The combination of IL-6 or CRP or hs-CRP could therefore be vital for the diagnosis and would be better predictors of neonatal sepsis and may be crucial in the pathogenesis of the disease.

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Umbilical Cord Blood Culture in General in the Diagnosis of Sageis Newborns

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i2930893 ◽

2020 ◽

pp. 126-131

Author(s):

Naredra P. Porval ◽

Kanvikar Reshmi ◽

D. B. Potdar ◽

S. B. Karanjkar

Keyword(s):

Risk Factors ◽

Birth Weight ◽

High Risk ◽

Blood Culture ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Neonatal Sepsis ◽

Venous Blood ◽

Peripheral Venous Blood

Worldwide neonatal sepsis is among the most frequent causes of neonatal death. Various studies have tried to establish the relationship between prevalence of neonatal septicemia risk factors and bacteriological profiling, low birth weight, prematurity, etc. Current study was aimed to compare early onset of neonatal sepsis (EONS) among primigravida and multigravida mothers using umbilical cord blood (UCB) and peripheral venous blood (PVB) samples. It was also aimed to establish the utilization of umbilical cord blood culture (UCBC) in comparison to peripheral venous blood culture (PVBC) in identifying EONS. In present study the blood samples were collected from high risk neonates for the clinical blood culture and screening. Among the 75 neonates in the study, 24 (32.0%) were observed to have sepsis screen positive. Study of high risk neonates umbilical cord blood culture (UCBC) positivity was 17.3% while Peripheral Venous blood culture positivity was 5.3%. Moreover, in this study all risk factors like Prematurity, Low birth weights, Premature rupture of membrane, and birth asphyxia were significantly (p<0.05) associated with UCBC growth/positivity. Low birth weight (86%) was mostly reported in the high risk neonates with other associated sepsis factors. Similarly maternal fever and prolonged rupture of membrane was highly significantly (p<0.01) associated with UCBC positivity. Gram negative bacterias were more commonly found, such as Pseudomonas (5.3%), followed by E. coli (4%), and Klebsiella (2.7%) and gram positive Streptococcus sp. (2.7%), etc. From our analysis it can be said that the UCBC has strong diagnostic outcomes as compared to the PVBC for etiological evaluation of bacterial sepsis in neonates at high risk.

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Gastric aspirate cytology as a screening tool for neonatal sepsis: a prospective study from a tertiary care centre

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182585 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1662

Author(s):

Ranjith Kumar ◽

Bhaskar Reddy ◽

Chapay Soren ◽

Venkataramana Reddy ◽

Raheemunisa .

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Neonatal Sepsis ◽

Screening Tool ◽

Tertiary Care ◽

Neonatal Infection ◽

Gastric Aspirate ◽

Tertiary Care Centre ◽

High Power Field ◽

Culture Negative

Background: Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first 28 days of life. It is responsible for 30-50% of the total neonatal deaths each year in developing countries. Gastric aspirate cytology has been used for neonatal infection. The presence of more than five polymorphs per high power field co-relate with neonatal infection. The objective of the present study was to evaluate the utility of gastric aspirate cytology as a screening tool for neonatal sepsis and to determine the polymorphonuclear leukocytes count in smear of gastric aspirate and correlating it with culture proven sepsis.Methods: This prospective observational study was conducted from February 2017 to January 2018 at level III Neonatal intensive care Unit of Sri Venkata Sai Medical College and Hospital, Mahabubnagar, Telangana. A total of 108 neonates with risk factor and / or clinical features of sepsis were included in the study.Results: Out of 108 neonates, 40 were blood culture positive and 68 were culture negative. Gastric aspirate smear showed ≥5 polymorphs in 30 and <5 polymorphs in 10 neonates with positive blood culture. Among blood culture negative cases, 20 had ≥5 polymorphs and 48 had <5 polymorphs in gastric aspirate smear. Gastric aspirate culture was positive in 48 neonates and negative in 60 neonates. Of the 48 gastric aspirate positive neonates, 45 had ≥5 polymorphs and 3 had <5 polymorphs in gastric aspirate smear. Similarly, among 60 gastric aspirate culture negative neonates, 55 had ≥5 polymorphs and 3 had <5 polymorphs in gastric aspirate smear. This was statistically significant (P<0.000001). Of 48 neonates with positive gastric aspirate culture, 30 had positive blood culture and 18 had negative blood culture.Conclusions: Gastric aspirate cytology is a good screening tool for neonatal sepsis added to a detailed perinatal history and clinical examination but does not completely substitute the present day available screening parameters.

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