Serum Secretory phospholipase A2 and interleukin-1beta for prognosis and mortality perdiction in neonatal sepsis

ABSTRACT

To evaluate the measurement of IL-lbeta and sPLA2 for the diagnosis of neonatal Sepsis as well as their relation to severity and outcome. The current study was carried out on 40 full term neonates [23 males and 17 females] selected from the Neonatal Intensive Care Unit and the General Nursery of Gynecological and Obstetric Hospital of Ain Shams University. The studied neonates were divided into two groups Group I included 25 neonates with neonatal sepsis 15 males and 10 females. Their postnatal age ranged between 3-21 days [mean +/- SD 7.12 +/- 4.04 days] they were 14 neonates with early onset sepsis and 11 neonates with late onset sepsis. Group II included 15 healthy neonates 8 males and 7 females served as control group. Their postnatal age ranged between 3-21 days [mean +/- SD 10.6 +/- 3.66 days]. All neonates underwent full history taking, thorough clinical examination, complete blood count, CRP level, blood culture, measurement of serum IL-lbeta, and sPLA2. A second sample was withdrawn after one week from seven cases who were improved clinically, to measure serum CRP, IL-lbeta, and sPLA2. the result of this study demonstrate that IL-lbeta was significantly higher in the septic group in comparison with the control group [21.10 +/- 9.79 vs. 4.90 +/- 3.58 pg/ml respectively, P<0.0001] and declined after antibiotic therapy [16.91 +/- 9.3 vs. 9.55 +/- 3.2, P<0.05]. No significant difference between early onset sepsis and late onset sepsis neonates was observed in regards IL-1beta, and sPLA2. Also significant elevations in IL-1beta levels in non-survivors than survivors of the septic group were observed [28.37 +/- 11.93 vs. 18.27 +/- 7.40pg/ml respectively, P<0.05]. Furthermore, secretory PLA2 [sPLA2] was significantly higher in the septic group in comparison with the control group [185.20 +/- 64.42 vs. 63.53 +/- 33,52 U/ml respectively, P<0.0001]. sPLA2 was significantly lower after antibiotic therapy [164.29 +/- 90.94, vs.57.14 +/- 15.77 U/ml, P<0.05]. Higher levels of sPLA2 were observed in non-survivors when compared with survivors of the septic group [243.43 +/- 34.54 vs. 162.56 +/- 59.15 U/ml respectively, p< 0.001]. A positive correlation between the level of IL-lbeta and sPLA2 was observed in the septic group [r = 0.78, P<0.0001] and the rate of change of sPLA2 was higher than IL-1beta after antibiotic therapy [61.23% vs. 46.57% respectively]. In conclusion, IL-lbeta and sPLA2 played a role in pathogenesis of neonatal sepsis. Moreover, their measurements could be used for diagnosis of neonatal sepsis and for prediction of prognosis and mortality