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Granulocyte-macrophage colony-stimulating factor and interleukin-5 concentrations in premature neonates with
D A Calhoun1, S E Sullivan, M Lunøe
1Department of Pediatrics, University of Florida College of Medicine, Gainesville 32610-0296, USA.
Insights
Eosinophilia is common in premature infants, often linked to infections. Cytokines like IL-5 and GM-CSF do not appear to drive eosinophilia in most cases, except for one severe instance.
Area of Science:
- Neonatal immunology
- Pediatric hematology
Background:
- Eosinophilia is frequently observed in premature neonates.
- The specific cytokines influencing neonatal eosinophilia remain largely unknown.
- Granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-5 (IL-5) are implicated in adult eosinophilia.
Purpose of the Study:
- To prospectively investigate the correlation between GM-CSF, IL-5, and the development of eosinophilia in premature infants.
- To understand the role of these cytokines in the pathogenesis of neonatal eosinophilia.
Main Methods:
- Prospective study measuring absolute eosinophil count (AEC) in 201 premature neonates.
- Serial serum concentrations of GM-CSF and IL-5 were measured in neonates with eosinophilia.
- Correlation analysis between AEC and cytokine levels was performed.
Main Results:
- Eosinophilia (AEC > 700/microliter) occurred in 10.5% of neonates.
- Most cases were associated with infection or necrotizing enterocolitis.
- GM-CSF and IL-5 levels were generally below detection limits and did not correlate with AEC, except for one severe case with elevated IL-5 preceding eosinophil peak.
Conclusions:
- Neonatal eosinophilia is common and can be prolonged in severe cases.
- Infections and necrotizing enterocolitis are frequently associated with eosinophilia onset.
- IL-5 and GM-CSF do not appear to be primary drivers of eosinophilia in most premature neonates, with limited evidence in severe cases.
Objective:
Eosinophilia is common among premature neonates, but little is known about the cytokines responsible for influencing its onset in neonates. In adults and transgenic mice, granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-5 (IL-5) influence the development of eosinophilia. We sought to prospectively determine whether these cytokines correlated with the development of eosinophilia in premature infants.
Study Design:
We measured the absolute eosinophil count (AEC) and serial serum concentrations of GM-CSF and IL-5 in premature neonates with eosinophilia.
Results:
Among 201 premature neonates, 21 had an eosinophil count of > 700/microliter (occurrence, 10.5%). Of these 21 neonates, 4 had mild (700/microliter to 999/microliter), 13 had moderate (1000/microliter to 2999/microliter), and 4 had severe (> 3000/microliter) eosinophilia. No differences in gestational age or age at onset of eosinophilia were observed between the groups, but the duration of eosinophilia was less with mild than with moderate or severe eosinophilia. A total of 20 of the 21 patients had an infection or necrotizing enterocolitis diagnosed within 48 hours of the onset of eosinophilia. In patients with mild and moderate eosinophilia, serial GM-CSF and IL-5 concentrations were below the lowest enzyme-linked immunosorbent assay standard. There was no correlation between AEC and GM-CSF or IL-5 concentration in these infants. However, in one patient with severe eosinophilia, two distinct elevations in IL-5 were noted (34.6 and 46.0 pg/ml); each peak occurred 7 to 8 days before a peak in eosinophil count.
Conclusion:
Eosinophilia is relatively common, and in those neonates with the highest AECs, the duration of eosinophilia can last for > 6 weeks. The majority of cases of eosinophilia occurred in temporal proximity to an infectious illness or necrotizing enterocolitis. Serum concentrations of IL-5 were elevated in only one of our patients with severe eosinophilia.