[Elastase-alpha 1-proteinase inhibitor in diseases of the neonatal period]

Elastase, a neutral protease stored in the azurophilic granules of neutrophils, is immediately released during the process of phagocytosis and rapidly bound and inactivated by alpha 1-proteinase inhibitor. This complex (E-alpha 1-PI) is highly stable and can be identified by ELISA-technique. In our study 95% of all infants with neonatal septicemia and/or meningitis had significantly increased plasma levels of E-alpha 1-PI at the time of diagnosis (n = 37). After initiation of therapy normalization of E-alpha 1-PI levels was observed in all neonates who recovered from infection. These data suggest that E-alpha 1-PI is a sensitive and rapidly responsive indicator of neonatal septicemia. In addition E-alpha 1-PI may be helpful in monitoring the course of the disease. However, the specificity of E-alpha 1-PI is rather low: in patients with local infections and inflammatory processes such as neonatal pneumonia, enterocolitis and meconium aspiration E-alpha 1-PI levels were also shown to be increased. In contrast, all patients with hyaline membrane disease had E-alpha 1-PI levels within the normal range.