Immunologic markers in the neonatal period: diagnostic value and accuracy in infection

DIAGNOSTIC VALUE PARAMETERS OF ACUTE PHASE REACTANCES OF INFECTIOUS-INFLAMMATORY PROCESS IN DIAGNOSTICS OF EARLY NEONATAL SEPSIS

An advanced progress of clinical neonatology in recent years has enabled to achieve considerable success in newborn management with due respect to both medical treatment and general care, especially in the group of neonates with low body weight at birth. At the same time, neonatal sepsis in the early period still predetermine sickness and mortality of newborns. Material and methods. Clinical-paraclinical indices with detection of diagnostic value of C-reactive protein and interleukins-6 and 8 were evaluated in 100 neonates with available susceptibility factors to early neonatal infection from mother’s side and clinical signs of organ dysfunction in neonates with precautions of generalized infectious-inflammatory process at the end of their first day of life. Results. The data obtained substantiate that low concentrations of IL-6 and IL-8 prevail, and therefore the mentioned mediators hardly can be used to verify early neonatal infection. In the majority of children C-reactive protein elevated the concentration of 10.0 mg/L which is traditionally considered to be a discriminant as to the verification of an infectious process in newborns. Conclusions. None of the clinical signs associated with infectious-inflammatory process in newborns in the first two days of their life enabled to verify reliably availability of systemic bacterial infection.

Emerging biomarkers for the diagnosis of severe neonatal infections applicable to low resource settings

More than 500 000 children die each year in low resource settings due to serious neonatal infections. Better diagnostics that can be utilized in these settings to identify infected infants have the potential to significantly reduce neonatal deaths and the associated morbidity. A systematic review was performed and identified more than 250 potential new biomarkers for the diagnosis of serious neonatal infections. Eight of these biomarkers were both high-performance and high-abundance (antithrombin, inter-α inhibitor proteins, interferon-γ inducible protein-10, interleukin-1 receptor antagonist, LPS binding protein, mannose binding lectin, serum amyloid A, resistin, visfatin), and are promising for the diagnosis of serious neonatal infections in low resource settings. Future clinical trials comparing these biomarkers with more traditional biomarkers seem warranted.