RESUMEN
Infection in the neonate presents a diagnostic dilemma as the clinical presentation is non- specific and final culture results are usually not available until at least 48-72[h] after sampling. Early confirmation of definitive infection with use of cytokine levels would cause significant reduction in health care costs by shortening the duration of treatment and hospitalization. The objective of the present study was to evaluate interleukin 6 [IL6] level in the early diagnosis of neonatal sepsis. This single blind clinical trial was done in NICU of Ghaem Hospital in 2003 - 2004. Subject included 60 neonates evaluated for suspected sepsis. All infants had IL6, CBC, B/C, CRP done at evaluation presentation. Infants were categorized into groups according to the Iikehood of infection on the basis of clinical presentation, blood culture results, i.e., group I [sepsis], group 2 [clinical sepsis] and group 3 [control]. IL6 was compared between two groups by the T-test of mann - whitney; logistic regression was done to establish the best predictors of infection; and sensitivity, specificity, positive and negative predictive values were determined. The lL6 Level was significantly raised in those infants with sepsis [184 pg/mL p value=0.000] and clinical sepsis [102 pg/ml p value= 0.001] when compared to those infants without infection [5 pg/ml]. An IL6 Value >/-11 pg/ml gave a NPV=9617%, PPV=100%, specifity=100%, sensitivity=96/8%. A CRP> 6pg/ml gave a sensitivity and specificity of 75% and 68% respectively. It is concluded that an IL6 value done at the time of presentation of sign and symptoms, suggestive of infection, is useful in the early diagnosis of neonatal sepsis. In particular, an IL6 < 11 and CRP < 6 pg/ml may allow antibiotics to be withheld in a number of infants evaluated for sepsis
RESUMEN
The Conventional treatment for neonatal immune hemolytic disease is, phototherapy and blood exchange transfusion. The aim of this study was to determine the efficasy of multiple dose of IVIG in reducing the need for exchange transfusion and phototherapy in hemolytic jaundice of newborn. The study was performed at NICU of Ghaem Hospital as a case - control study, over a period of one year [oct 2002-oct 2003]. Patients with ABO and RH incompatibility, proven by significant hyperbilirubinemia [Bill>8mg/dl at 12hr of age], positive direct or indirect comb's, and no other Risk factors, like sepsis and G6PD deficiency or early familial icterus, were randomly assigned to receive either conventional intensive phototherapy alone or phototherapy with IVIG 0.5gr/kg every 12hr for three times. Exchange transfusion was performed if billirubin exceded more than 20mg/dl. A total of 34 newborn infants were included in the study. There was no significant difference between two groups, with respect to birth weight, postnatal age, sex, bilirubin, hematocrit, or reticulocite count. The number of exchange transfusion, duration of phototheray and hospitalization, were significantly lower in IVIg treatment group than control one. Adverse effects were not observed during IVIG treatment. IVIG therapy is a safe treatment for newborns with hemolytic jaundice and Reduces exchange transfusion