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Monocyte phagocytosis as a reliable parameter for predicting early-onset sepsis in very low birthweight infants.

Abstract：

BACKGROUND:Septic complications lead to a high mortality rate in very low birthweight infants (VLBWI). Therefore, prognostic markers for the development of sepsis attach importance to start an efficient therapy as early as possible. AIMS:Functional and phenotypical variables of blood monocytes in the cord and peripheral blood were investigated to evaluate the parameters for predicting early-onset and late-onset sepsis (nosocomial infections). STUDY DESIGN:In a prospective study, 25 VLBWI were investigated. METHODS:In the cord blood taken immediately after birth, the capacity of the monocytes to phagocytose non-opsonized E. coli bacteria by flow cytometry and the ex-vivo production of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta and IL-6 (enzyme-linked immunoassay (ELISA)) after lipopolysaccharide (LPS) stimulation were measured. At the third day, the HLA-DR expression on the monocytes (flow cytometry) and the LPS-induced cytokine production were measured from the peripheral blood. RESULTS:Five VLBWI already developed early septic complications after 24-72 h, while the other three infants had late-onset sepsis 10-18 days after birth. The prognostic significance for early-onset sepsis was highest for the decreased monocyte phagocytic capacity (sensitivity and specificity: 100%) and for the LPS-induced formation of TNF-alpha and IL-1 beta in cord blood. Moreover, in septic VLBWI, the HLA-DR expression on the monocytes was lowered on day 3 after birth. The prognostic significance for late-onset sepsis was highest for TNF-alpha and IL-1 beta levels in the peripheral blood on the third day after birth. CONCLUSIONS:The determination of phagocytosis in the cord blood seems to be a reliable parameter for predicting early-onset sepsis and offers the possibility for a forward start of an antibiotic therapy.

journal_name

Early Hum Dev

journal_title

Early human development

authors

Hallwirth U,Pomberger G,Zaknun D,Szepfalusi Z,Horcher E,Pollak A,Roth E,Spittler A

doi

10.1016/s0378-3782(01)00245-6

keywords:

subject

Has Abstract

pub_date

2002-04-01 00:00:00

pages

1-9

issue

1-2

eissn

0378-3782

issn

1872-6232

pii

S0378378201002456

journal_volume

pub_type

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Monocyte phagocytosis as a reliable parameter for predicting early-onset sepsis in very low birthweight infants.