62 newborn infants of whom twenty four neonates were affected by septicemia as proved by positive blood culture (group I) and twenty three neonates with suspected sepsis as diagnosed by clinical manifestations, while the blood culture was negative (group II). On addition, fifteen healthy newborn infants as a control group (group III).On admission all cases were clinically examined, and ail the required cultures were taken with radiological examination if necessary, serum samples for measuring the levels of TNF-a, IL-6 and CRP were collected. Antibiotics were administered to neonates in group I and II, another serum samples were collected after 48 hours from admission for measuring the levels of TNF-a, IL-6 and CRP to study the effect of treatment on their levels and correlate these levels with the outcome of the diseaseJn this prospective study we found that serum levels of both TNF-a and IL-6 are increased in neonates with septicemia early in the course of the disease. The levels of these cytokines on admission and 48 hours after are related to the severity and outcome of the illness, so, the levels in non survivors were much higher than in survivors.We observed that, after the start of therapy with antibiotics, both TNF-a and IL-6 serum levels decreased concomitantly with the improvement of the clinical situation within two days. In non survivor casses, the treatment was not effective and the serum levels of TNF-a and IL-6 still as high as before treatment or may even became higher.The sensitivity and specificity of both cytokines to diagnosis septicemia were 87.5% and 65.2% respectively for TNFa and 91.7% & 73.9% for IL-6. When combined with each other a positive test result for both has a sensitivity of 95.8% and a specificity of 78.3%.We detected that CRP also, is a good diagnostic tool specially late in the course of the disease, and when it was used in diagnosis of septicemia in combination with any of the two cytokines, the diagnosis of septicemia is almost certain, CRP and IL-6 gives us a sensitivity of 100% and specificity of 78.3% while, CRP with TNF-a gives us a sensitivity of 100 % and specificity of 73.9% in diagnosing septicemia.We concluded that, although the method that we and others have used to measure TNF-a and IL-6 serum levels is slow for any clinical purpose in neonates with sepsis, the relationship found between TNF-a and IL-6 levels and the outcome of the patients suggests that the development of faster methods for determining their levels could make this assay an early prognostic indicator of sepsis in newborns. |
