Reactive hyperemia and interleukin 6, interleukin 8, and tumor necrosis factor-alpha in the diagnosis of early-onset neonatal sepsis

Objective. To evaluate the diagnostic value of peripheral circulatory react ive hyperemia and serum levels of interleukin-6 (IL-6), IL-8, and tumor nec rosis factor-alpha (TNF-alpha) in early-onset neonatal sepsis. Methods. Reactive hyperemia in the dorsal hand and serum levels of IL-6, IL -8, and TNF-alpha were studied in newborn infants (n = 32; gestational age 39 +/- 3 weeks) who had been admitted to the neonatal unit because of suspe cted sepsis <48 hours after birth. On admission, reactive hyperemia after a standardized arterial occlusion was measured with laser Doppler technique, and blood samples were taken for cytokine analyses. On the basis of predet ermined criteria, the infants subsequently were classified as septic (n = 1 2) or not (n = 20). Results. The degree of reactive hyperemia was higher in the group with seps is (median +170% perfusion increase) than in that without (+37%). On admiss ion, serum levels of IL-6, IL-8, and TNF-<alpha> all were higher in septic (median values: 1620, 331, and 22 pg/mL, respectively) than in nonseptic ne onates (median values: 42, 63, and 13 pg/mL, respectively). In the group wi th sepsis, the degree of reactive hyperemia correlated to log IL-6 (r = 0.8 0) and log IL-8 values (r = 0.71). Conclusion. Newborn infants with septicemia have increased reactive hyperem ia and elevated cytokine levels very early in their disease. Reactive hyper emia in skin can be analyzed at the bedside and noninvasively and therefore may serve as an additional diagnostic tool in neonatal sepsis.