The Journal of Maternal-Fetal & Neonatal Medicine

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The Journal of Maternal-Fetal & Neonatal Medicine

ISSN: 1476-7058 (Print) 1476-4954 (Online) Journal homepage: http://www.tandfonline.com/loi/ijmf20

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Cytokine profile as diagnostic and prognostic factor in neonatal sepsis

Yelda A. Leal, José Álvarez-Nemegyei, Ana I. Lavadores-May, Jorge Luis Girón- Carrillo, Roberto Cedillo-Rivera & Juan R. Velazquez

To cite this article: Yelda A. Leal, José Álvarez-Nemegyei, Ana I. Lavadores-May, Jorge Luis Girón-Carrillo, Roberto Cedillo-Rivera & Juan R. Velazquez (2018): Cytokine profile as diagnostic and prognostic factor in neonatal sepsis, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2018.1449828

To link to this article: https://doi.org/10.1080/14767058.2018.1449828

[pic 3]   Published online: 21 Mar 2018. [pic 4]   Submit your article to this journal[pic 5][pic 6]

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THE JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, 2018[pic 14][pic 15][pic 16]

https://doi.org/10.1080/14767058.2018.1449828[pic 17]

ORIGINAL ARTICLE        [pic 18]

Cytokine profile as diagnostic and prognostic factor in neonatal sepsis

Yelda A. Leala, Jos´e A´lvarez-Nemegyeib, Ana I. Lavadores-Mayc, Jorge Luis Giro´n-Carrillod,

Roberto Cedillo-Riverae and Juan R. Velazquezf [pic 19]

aCancer Population Record of Merida, Medical High Speciality Unit, Mexican Institute of Social Security (IMSS), Merida, Yucatan, Mexico; bStar Medica Hospital, Merida, Yucatan, Mexico; cDepartment of Clinical Neonatology, Regional Hospital 1, IMSS. Merida, Yucatan, Mexico; dGeneral Hospital 1, IMSS. Zacatecas City, Zacatecas, Mexico; eClinic and Epidemiology Interinstitutional Research Unit, Medicine Faculty, Autonomous University of Yucatan, Merida, Yucatan, Mexico; fAllergy and Immunogenetics Department, National Institute of Respiratory Diseases (INER), Mexico City, Mexico

ARTICLE HISTORY[pic 20]

Received 10 January 2018

Revised 22 February 2018

Accepted 6 March 2018

KEYWORDS

Cytokines; diagnosis; neonatal sepsis; prognosis; risk

Introduction

Neonatal sepsis is a public health problem worldwide, with high rates of morbimortality, especially in develop- ing countries [1–4]. Its effect on survival is especially harmful in neonates with high biological vulnerability,

i.e. premature neonates and neonates with low birth weight (LBW) [5,6]. Neonatal sepsis had an average glo- bal mortality rate of 49.7%, with variability between 40% and 80%, depending on the geographic area [7,8]. In a previous study carried out by our work group with 11,790 newborns, we documented an incidence of neonatal sepsis of 4.3% and a mortality of 9.5% [9]. Additionally, sepsis-associated neonatal mortality is related with its time of appearance. It has been esti- mated that early-onset sepsis (at 1–3 d of life) reaches 50%, while for late-onset sepsis (at 4–28 d of life), this is 15% [1,2,10,11]. Neonates who survive the systemic infection can present permanent neurological sequelae,

due to the affectation of the nervous system produced by septic shock or severe hypoxia associated with parenchymal lung disease [12–14].

The diagnosis of neonatal sepsis is especially difficult, in contrast with that of systemic infections that occur in other pediatric groups and in adults. The clinical condi- tion of neonatal sepsis shows unspecific signs and symptoms, such as thermal dysregulation, lethargy, irrit- ability, tachypnea, arterial hypotension, delay in capillary refill, oliguria, and abdominal distension [15–17].

Despite the relative immunological immaturity char- acteristic of the perinatal period, it has been demon- strated that the innate and adaptive mechanisms of immune response evoked by the specific molecular patterns of pathogens and microbial antigens result in the production and release of cytokines into the body fluids, which possess regulatory functions of the immune response, exerting effects on the infection’s clinical signs and the outcome [18–21].

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CONTACT  Juan  R.  Velazquez  [pic 22]   velazquez_juan@outlook.com     [pic 23]Departamento  de  Inmunogen´etica  y  Alergia,  Instituto  Nacional  de  Enfermedades Respiratorias (INER), Ciudad de M´exico (CDMX) CP 14080, Mexico

© 2018 Informa UK Limited, trading as Taylor & Francis Group

2        Y. A. LEAL ET AL.[pic 24]

There is evidence that demonstrates that the serum levels of some cytokines can be useful for early diagno- sis of sepsis in neonates with a high index of clinical suspicion. Prior to the elevation of acute-phase reac- tants, changes have been observed in the serum con- centrations of proinflammatory cytokines IL1b, IL-6, IL-8, and TNFa, and in anti-inflammatory cytokines IL10 and TGFb [22–28]. However, measurement of serum levels of cytokines is not advised in guidelines for the diagno- sis of neonatal sepsis, due to the technical problems inherent in their measurement, its high cost, the lack of automation in the methodology of their quantification, and a relative inconsistency in the results [15–17,29–31]. We consider that a reliable measurement of a serum panel of cytokines could be useful in the prediction of the development of sepsis in neonates at high risk, or even in the outcome of the infection. We conducted the present cohort study in a group of neonates with high risk of developing sepsis, with the objective of identify- ing the association among cytokine levels, the risk of

developing sepsis, and the prognosis of the latter.

Materials and methods

Study population

We conducted a cohort study in neonates who were admitted to the Neonatology Service of the Mexican Institute  of  Social  Security  (IMSS)  Ignacio  Garc´ıa  T´ellez Medical  Center  in  M´erida,  Yucat´an,  Mexico,  between September 2011 and September 2012. We included in the cohort newborns with a gestational of between 27 and 42 weeks, independent of birth weight, and with one or more risk factors for sepsis.

Definition of neonatal sepsis

The clinical statuses of the neonates on the continuum of the phenomenon of neonatal sepsis deriving from inflam- matory response syndrome, sepsis, severe sepsis, septic shock, and multiorgan failure were performed according to the 2015 Criteria emitted by the International Pediatric Sepsis Consensus Conference [29].

Follow-up

We included in the study all neonates who were admit- ted to the Neonatology Service, with the written informed consent of the parent or guardian. By means of a questionnaire, we obtained the following data: (a) gestational age, birth weight, and maternal age; and (b) perinatal data as follows: premature rupture of mem- branes (PROM); maternal infection (cervicovaginitis and chorioamnionitis); fever during delivery; prenatal use of

an antibiotic or glucocorticoids; delivery type; Apgar score at min 1 and at min 5 of life; prolonged expulsive period; obstetric trauma, and perinatal asphyxia. Later, we obtained a venous blood sample. Each neonate included in the cohort was submitted to an exhaustive evaluation of the clinical state at least once during each hospital work shift, seeking to detect changes in his/her status. All of the neonates included were monitored until their hospital discharge, registering at that time the type of outcome: healthy neonate; discharge with severe sequelae, or death.

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