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The prognostic virtue of inflammatory markers during late-onset sepsis in preterm infants
Shmuel Arnon1, Ita Litmanovitz, Rivka Regev
1Department of Neonatology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel. harnon@netvision.net.il
Insights
Serum amyloid A (SAA), C-reactive protein (CRP), and white blood cell (WBC) counts can predict outcomes in preterm infants with late-onset sepsis (LOS). Lower levels of these markers indicate a poorer prognosis, with SAA being the earliest indicator.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Critical Care Pediatrics
Background:
- Late-onset sepsis (LOS) is a significant threat to preterm infants.
- Understanding prognostic markers is crucial for managing LOS in this vulnerable population.
Purpose of the Study:
- To evaluate the prognostic value of acute phase inflammatory response markers in preterm infants with LOS.
- To compare inflammatory responses in infants with fulminant sepsis versus non-fulminant sepsis.
Main Methods:
- Analyzed 42 preterm infants (10 fulminant sepsis, 32 non-fulminant sepsis).
- Measured C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6), and white blood cell (WBC) counts at multiple time points.
- Compared marker levels between infants who died and those who recovered.
Main Results:
- Fulminant sepsis cases were characterized by small for gestational age infants and fewer antibiotic days.
- Initial inflammatory marker levels were similar, but decreased significantly by 8 hours in the fulminant group.
- Lower SAA, CRP, and WBC counts at 8 and 24 hours correlated with mortality.
- Decreased inflammatory markers preceded metabolic acidosis and hypotension in fulminant sepsis cases.
Conclusions:
- SAA, CRP, and WBC counts serve as effective prognostic markers for LOS in preterm infants.
- SAA is identified as the earliest prognostic marker for predicting outcomes in neonatal sepsis.
Aim:
Late-onset sepsis (occurring after the first three days of life) is a serious complication in preterm infants. In order to assess the possible prognostic virtues of the acute phase inflammatory response in the disease, we compared the inflammatory response of preterm infants who died within 72 hours (h) (fulminant sepsis) to infants who recovered from the disease (non-fulminant sepsis).
Methods:
Of 42 preterm infants that were evaluated: 10 had fulminant sepsis and 32 non-fulminant sepsis. Acute phase inflammatory response markers-C-reactive protein (CRP), serum amyloid A (SAA), interleukin (IL)-6 levels and white blood cell (WBC) counts were measured at the first suspicion of LOS and after 8, 24 and 48 h.
Results:
Small for gestational age (SGA) infants who were treated with fewer days of antibiotics characterized the fulminant sepsis group. The initial high levels of inflammatory markers were similar in both groups, but as early as 8 h after onset significantly lower levels of SAA, CRP and WBC counts were documented in the fulminant sepsis group. The inflammatory response remained low at 24 and 48 h in the fulminant sepsis group, while in the survivors, significantly increased inflammatory markers were measured. Decreases in the levels of the inflammatory markers preceded episodes of metabolic acidosis and arterial hypotension that were more common in the fulminant sepsis group. Infant mortality correlated inversely with SAA levels at 8 h and with CRP and WBC counts at 24 h after onset.
Conclusion:
SAA, CRP and WBC counts can be used as prognostic markers in LOS in preterm infants, with SAA being the earliest prognostic marker.