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INTRODUCTION: Preterm neonates have under-developed immune-regulatory system; consequently, there is a risk for developing chronic inflammation. Necrotizing enterocolitis (NEC) is an acute devastating neonatal intestinal inflammatory disorder. Due to the obscure multifactorial etiology, early diagnosis and effective treatment of NEC are limited. Consequently, effective strategies in the prevention of NEC, including nutritional approaches, are critically needed. The current study was conducted to assess the potential immunomodulatory effect of Docosahexaenoic Acid (DHA) supplementation in preterm neonates at neonatal intensive care unit (NICU) and subsequently its effect on preventing or reducing NEC incidence. METHODS: This was a prospective randomized controlled study. A total of 67 neonates, with gestational age equal or less than 32 weeks at birth and weight less than or equal 1500 g, were randomly assigned to either DHA group or the control group. Modified Bell's staging criteria for NEC was used as an objective tool for diagnosis and staging of NEC. Levels of Interleukin 1 beta (IL-1ß) were measured at baseline and after 10 days. Mortality and NICU length of stay (LOS) were also monitored. RESULTS: Thirty neonates of each group completed the study. A statistically significant difference was observed between the two groups regarding diagnosis and staging of NEC (p = 0.0001). There was also a statistically significant difference between DHA group 22(73.3), 95% CI [55.9, 86.5] and the control group 8 (26.7), 95% CI [13.5, 44.1] in the percentage change in IL-1ß levels (p = 0.0001).A statistically significant association was found between IL and 1 ß change and NEC diagnosis (p = 0.001). NICU LOS was significantly lower among DHA group 21.63 ± 6.67 compared to the control group 25.07 ± 4.67 (p = 0.025). Mortality n (%) among the control group 4 (11.8) was higher than DHA group 3 (9.1), however, no significant difference was detected (p = 1.0). CONCLUSION: Findings of this study suggest that enteral DHA supplementation can reduce NEC incidence in preterm neonates through its immunoregulatory effect that modulates production of regulatory cytokines.Trial registration: Registered at clinical trials.gov (NCT03700957), 6 October 2018.
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Neonatal sepsis remains a major cause of mortality and morbidity in neonates, Traditional methods for diagnosis like blood culture has a low sensitivity and delayed results in neonates. This study aimed to measure the level of interleukin-27 (IL-27) in sera of patients with neonatal sepsis to determine its potential role as a biomarker for diagnosis of bacterial sepsis. This prospective study included 90 neonates with suspected neonatal sepsis. Plasma levels of IL-27 were measured using an ELISA; blood culture, 16s r DNA and C-reactive protein (CRP) level were done to diagnose sepsis. The ROC curve analysis was performed to evaluate the predictive ability of IL 27 and CRP individually and in combination to identify bacterial sepsis in neonates. The Studied neonates were divided into 45 patients with neonatal sepsis and 45 uninfected systemic inflammatory response syndrome (SIRS) patients as controls. 30 neonates in the infected group were identified by positive blood culture results (66.6%) and 15 patients were identified by being positive for 16s r DNA (33.3%). For IL- 27, the ROC area under the curve (AUC) was 0.991 and a cut-off point of > 485.56 with sensitivity of 95.56% and a specificity of 100%. For CRP, the AUC value was 0.933 and a cut-off point of > 32 with sensitivity of 88.89% and a specificity of 82.22%. In conclusion, our results indicated that elevated IL-27 correlated well with bacterial sepsis among neonatal patients with bloodstream infections and may provide additional diagnostic value along with other available biomarkers.
