CYTOKINE ELEVATIONS IN CRITICALLY ILL INFANTS WITH SEPSIS AND NECROTIZING ENTEROCOLITIS

We hypothesized that plasma levels of cytokines such as interleukin-6 and tumor necrosis factor (TNF) are elevated in critically ill infants with sepsis and necrotizing enterocolitis (NEC) and that the magnitud e of their elevation is correlated with mortality rate. We measured pl asma levels of interleukin-6 and TNF in 62 newborn infants with suspec ted sepsis or NEC. Eighteen infants had bacterial sepsis, 9 had bacter ial sepsis plus NEC, and 15 had NEC but negative culture results. Twen ty comparably ill infants with negative results on culture of systemic specimens served as study control subjects. Interleukin-6 levels were five- to tenfold higher in infants with bacterial sepsis plus NEC at the onset of disease than in infants with bacterial sepsis alone, in i nfants with NEC but negative culture results, and in control infants ( p < 0.01). These differences persisted throughout the 48-hour study pe riod. Interleukin-6 levels,were also significantly higher in nonsurviv ors than in survivors (p < 0.001). In contrast, plasma TNF values were not consistently increased in any of the groups. We conclude that pla sma interleukin-6 is a more reliable indicator of bacterial sepsis and NEC than plasma TNF and may identify infants who might benefit from i mmunotherapeutic strategies.