Circulating monocytes; HLA-DR expression in healthy and sick neonates

ABSTRACT

This study was conducted to measure Monocytes HLA-DR expression in neonatal sepsis in comparison to other diseases with systemic inflammation and high risk of infection [respiratory distress syndrome [RDS] and prenatal asphyxia] and this may be helpful in early diagnosis of infection and therapeutic intervention. This study was carried out on 2007 and it conducted on 38 sick neonates, 22 with proven sepsis diagnosed clinically and by positive blood culture and 16 [8 had RDS and 8 had prenatal asphyxia] with possible infection i.e. they had 2 or fewer clinical signs of sepsis and negative blood culture. Those Patients with possible infection were followed up [for 48 h]. Seven out of the 8 RDS Babies developed sepsis as evidenced clinically and by positive blood culture and they considered as patients with early sepsis at the time of admission. Forty healthy age and sex matched newboms were studied as controls. All Babies were subjected to complete blood count [CBC], C-reactive protein [CRP] and flow cytometeric determination of HLA-DR expression on monocytes. Neonates with proven sepsis and those with early sepsis [7/8 of RDS] had significantly lower HLA-DR% [15.9 +/- 7.8 and 11.4 +/- 5.9 respectively] than controls [61.0 +/- 20.6]. HLA-DR% was reduced below the lowest cut off values in all septicemic neonates [neonates with proven and those with early sepsis]. At the time of admission CRP was positive in 91% of neonates with proven sepsis and in only 57% of the neonates of early sepsis. In addition, there was no significant difference between HLA-DR percent in neonates with prenatal asphyxia when compared to control group. Monocytes HLA-DR% had higher sensitivity, specificity, positive and negative predictive values [100%, 85%, 87.5% and 100% respectively] compared to CRP [57.1%, 77.8%, 66.7%, 70% respectively] for neonatal sepsis at its early stages before evident clinical and laboratory diagnosis. HLA-DR% expression on monocytes is a sensitive test for both diagnosis of neonatal sepsis and its early stage and exclusion of neonatal infection in high risk neonates to reduce the unnecessary antibiotic use and the costs of neonatal intensive care units