PREDICTIVE VALUE OF SOLUBLE IMMUNOLOGICAL MEDIATORS IN NEONATAL INFECTION

1. Infection in the neonatal period is difficult to diagnose and is a significant cause of morbidity and mortality in preterm infants. 2. We investigated prospectively the predictive value of plasma measurement of bacterial endotoxin (lipopolysaccharide), tumour necrosis factor-a lpha, interleukin-6, interleukin-8, intercellular adhesion molecule-1 and C-reactive protein in 60 consecutive newborn infants suspected of having neonatal infection. Plasma samples were taken at the time of ac ute clinical deterioration. Sixty-two cord blood samples were studied as controls taken at elective Caesarean section. 3. Forty-three infant s had confirmed infections, 25 with positive blood cultures. Tumour ne crosis factor-alpha and bacterial endotoxin levels were not significan tly elevated over controls, whereas interleukin-6, interleukin-8 and i ntercellular adhesion molecule-1 levels were all significantly increas ed in the infected group compared with controls (all P < 0.001). 4. In creased plasma intercellular adhesion molecule-1 levels were a highly sensitive (88%) indicator of clinical infection and were independent o f C-reactive protein. Use of these two assays in combination improved the diagnostic sensitivity to 95% and gave a negative predictive value of 97%. Addition of interleukin-6 or interleukin-8 measurements faile d to further significantly enhance the prediction of infection. 5. Mea surement of intercellular adhesion molecule-1 level may have a clinica l role in rapidly confirming, or predicting, the likely diagnosis in c ases of suspected neonatal infection.