Plasma endothelin-1 and clinical manifestations of neonatal sepsis

Aim: To determine whether plasma endothelin-1 (ET-1) relates to clinical manifestations of sepsis in the newborn, especially with systemic hypotension, acidosis, severe hypoxemia (which may represent pulmonary hypertension) and oliguria. Methods: Prospective study of 35 consecutive newborns with clinical sepsis: 22 with hemoculture-positive (HC +) sepsis and 13 hemoculture-negative (HC -). Plasma ET-1 concentrations were measured within 2 days of the diagnosis of sepsis. SNAP-II severity score was performed at the time of highest clinical severity. Results: Newborns with HC+ sepsis had higher plasma ET-1 concentrations and SNAP-II scores (especially PO2/ FiO(2) ratio) than HC- septic children. Plasma ET-1 concentrations increased linearly with each item of the SNAP-II score, but only reached significant differences in lowest mean blood pressure (P=0.030), lowest pH (P = 0.048), multiple seizures (P = 0.010) and lowest urine output (P=0.013). Leukocyte count, immature/total neutrophil ratio and C-reactive protein value were not different. Each item of the SNAP-II score was independently related only to ET-II level. Oliguria, acidosis and systemic hypotension were more correlated (R-2>0.5). Conclusions: Plasma ET-1 levels in neonatal sepsis are related to the severity of clinical manifestations, especially oliguria, acidosis and systemic hypotension.