[Evaluation of quantitive IL6 in the diagnosis of neonatal sepsis]

ABSTRACT

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