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Changes in serum procalcitonin, interleukin 6, interleukin 8 and C-reactive protein in neonates after surgery
M Pavcnik-Arnol1, B Bonac, M Groselj-Grenc
1University Medical Center Ljubljana, Department of Pediatric Surgery and Intensive Care, Ljubljana, Slovenia. maja.pavcnik@kclj.si
Insights
Interleukin-8 (IL-8) shows a rapid, consistent response after neonatal surgery, potentially aiding infection monitoring. Procalcitonin (PCT), Interleukin-6 (IL-6), and C-reactive protein (CRP) kinetics vary, complicating interpretation.
Area of Science:
- Neonatal intensive care
- Surgical outcomes
- Biomarker kinetics
Background:
- Neonatal surgery involves complex physiological responses.
- Monitoring inflammatory markers is crucial for postoperative care.
- Interpreting procalcitonin (PCT) is challenging due to postnatal factors.
Purpose of the Study:
- To determine the serum concentration kinetics of PCT, IL-6, IL-8, and CRP.
- To analyze these marker changes after various neonatal surgical procedures.
Main Methods:
- Prospective observational study in a level III NICU.
- Enrolled 25 neonates undergoing major surgeries.
- Measured PCT, IL-6, IL-8, and CRP preoperatively and on PODs 0, 1, and 2.
Main Results:
- IL-6 and IL-8 showed significant, rapid increases post-surgery, peaking on POD 0 or 1.
- CRP levels rose slowly, peaking on POD 2.
- PCT concentrations varied significantly between patients, with an insignificant overall increase.
Conclusions:
- IL-6 is a sensitive marker of neonatal surgical injury, with variable responses.
- IL-8 offers a consistent, rapid, and transient response, suggesting potential for infection monitoring.
- CRP response is delayed, while PCT interpretation is complicated by postnatal physiology.
Introduction:
Aim of this study was to determine the kinetics of procalcitonin (PCT), interleukin-6 (IL-6), interleukin-8 (IL-8) and C-reactive protein (CRP) serum concentrations after different types of neonatal surgery.
Material And Methods:
We conducted a prospective, observational study in a level III multidisciplinary neonatal intensive care unit. We enrolled twenty-five (n=25) neonates undergoing major surgery (for gastroschisis, atresia of the small intestine, congenital diaphragmatic hernia, esophageal atresia, coarctation of the aorta, neurosurgical procedures). Serum PCT, IL-6, IL-8 and CRP were measured before surgery, immediately after surgery (POD 0) and on the first and second day after surgery (POD 1, 2).
Results:
Median preoperative serum concentrations were: PCT 1.3 microg/l, IL-6 985 fmol/l, IL-8 51 pg/ml, CRP 6 mg/l. PCT increased insignificantly after surgery with a peak median concentration on POD 1 (2.0 microg/l), but concentrations varied considerably between patients in the same category of surgery. IL-6 significantly increased on POD 0 (median 2 262 fmol/l), with a peak median concentration on POD 1 (3 410 fmol/l), and decreased thereafter. IL-8 increased significantly after surgery with a peak median concentration on POD 0 (125 pg/ml) and decreased thereafter. IL-8 response was very consistent after all types of surgery. CRP only began to increase on POD 1 (median 20 mg/l) with a peak median concentration on POD 2 (21 mg/l).
Conclusions:
The physiological increase in PCT after birth and the impact of underlying disease make the interpretation of postoperative values in the immediate postnatal period difficult. IL-6 is a very sensitive marker of neonatal surgical injury with considerable variation between different types of surgery. IL-8 response after neonatal surgery is similar after all types of surgery, very rapid and transient with relatively low concentrations. CRP response to surgery is slow with persistence of elevated levels throughout the study period. IL-8 could potentially be a useful marker for monitoring infection in the immediate postoperative period in neonates.