Inflammatory and oxidative parameters in cord blood as diagnostic of early-onset neonatal sepsis: A case-control study

Objective: To determine whether levels of interleukin (IL)-6, IL-10, and oxidative parameters in umbilical cord blood could contribute as an indicator of neonatal sepsis in recognized high-risk neonates. Design: Prospective, case-control study. Setting: Neonatal intensive care unit. Subjects: One hundred twenty consecutive preterm neonates who had at least one other risk factor for early-onset neonatal sepsis. Interventions: None. Measurements and Main Results: Umbilical cord blood samples were obtained for the determination of IL-6, IL-10, thiobarbituric acid reactive substances (TBARS), and protein carbonyls levels. Neonates were divided prospectively in two groups: control and septic. All parameters were higher in septic patients compared with control (IL-6 184.6 +/- 72.7 vs. 58.9 +/- 19.1, p < 0.01; IL-10 171.4 +/- 59.2 vs. 79.9 +/- 17.9, p < 0.01; TBARS 10.1 +/- 2.8 vs. 4.2 +/- 2.5, p < 0.01; protein carbonyls 2.4 +/- 1.2 vs. 1.15 +/- 0.5, p < 0.01, respectively, septic vs. control). In addition, these parameters were higher in the subgroup of culture-positive septic patients compared with control. IL-6 and TBARS had equivalent areas under the receiver operator characteristic (ROC) curve (0.88); IL-10 (0.80) and protein carbonyls (0.73) had lower areas. Multivariate logistic regression comparing IL-6 and TBARS in terms of the relative risk for neonatal sepsis demonstrated that TBARS was a better predictor, being independently associated with neonatal sepsis. Conclusion: Our findings demonstrated that cord blood IL-6, IL-10, and oxidative stress markers were significantly higher in infants with neonatal sepsis, and only TBARS levels were independently related to the development of neonatal sepsis in our sample. (Pediatr Crit Care Med 2009; 10:467-471)