PLASMA-LEVELS AND GENE-EXPRESSION OF GRANULOCYTE-COLONY-STIMULATING FACTOR, TUMOR-NECROSIS-FACTOR-ALPHA, INTERLEUKIN (IL)-1-BETA, IL-6, IL-8, AND SOLUBLE INTERCELLULAR-ADHESION MOLECULE-1 IN NEONATAL EARLY-ONSET SEPSIS

Bacterial sepsis is still a leading cause of neonatal morbidity and mo rtality. Early onset sepsis in particular, presents with a different c linical course and involves other pathogens than sepsis later in life. In this study, plasma concentrations and mRNA expression of granulocy te colony-stimulating factor (G-CSF), tumor necrosis factor-alpha (TNF -alpha), IL-1 beta, IL-6, IL-8, and soluble intercellular adhesion mol ecule-1 (sICAM-1) of neonates with early onset sepsis were evaluated i n cord blood and during the first days of life. Irrespective of premat urity, plasma levels of G-CSF, TNF-alpha, IL-1 beta, IL-6, and IL-8, b ut not sICAM-1, were excessively elevated in septic neonates when comp ared with both healthy infants and infants with clinically suspected b ut not confirmed sepsis. Compared with the corresponding maternal leve ls, neonatal cytokine cord plasma levels were likewise highly elevated , indicating the endogenous cytokine production by the neonate. With t he exception of TNF-alpha, mRNA expression in blood cells from septic infants was, however, not more frequently detectable than in those fro m nonseptic patients. Cytokine levels decreased significantly within t he first days of life, whereas levels of sICAM-1 and C-reactive protei n increased during the same time period. In summary, in contrast to C- reactive protein and sICAM-1, cord blood plasma levels, but not the pr esence of mRNA, of G-CSF, TNF-alpha, IL-1 beta, IL-6, and IL-8 can pre dict neonatal early onset sepsis with a high sensitivity and specifici ty. Cell types other than blood cells are likely to contribute conside rably to the high cytokine production in septic newborns.