Plasma citrulline levels in preterm neonates with necrotizing enterocolitis

Background and aim

Citrulline is a non-protein amino acid synthesized in the small intestine. In children with short-bowel syndrome, citrulline has served as a reliable marker of the residual bowel length and parenteral nutrition (PN) independence. In the present study we aim to assess the value of citrulline measurement in preterm neonates developing necrotizing enterocolitis (NEC).

Methods

Plasma citrulline levels were measured prospectively in 17 preterm neonates with NEC stage II during the entire course of the disease. Serial citrulline determinations in 24 healthy preterm neonates on 2, 7, 14, 21 and 28 days of life (DOL), served as reference values.

Results

In healthy preterm neonates plasma citrulline levels showed a progressive increase in relation to age. In neonates presenting with NEC, mean citrulline levels were significantly lower as compared to controls' citrulline levels of the most approximate day of life (DOL 7: 16.85 ± 4.2 vs 20.5 ± 4.5 μmol/L, p < 0.05; DOL 14: 18 ± 4.2 vs 23.5 ± 4.3 μmol/L, p < 0.01; DOL 21: 17 ± 2.5 vs 30 ± 5.7 μmol/L, p < 0.01). The optimal citrulline cut-off distinguishing NEC patient from controls was 17.75 μmol/L (sensitivity 76%, specificity 87%). Plasma citrulline at presentation correlated inversely with the duration of parenteral nutrition (r = − 0.49, p < 0.05). Consecutive citrulline determinations revealed that plasma citrulline increased during reintroduction and gradual increase of enteral nutrition.

Conclusions

Our findings provide preliminary evidence that citrulline levels that are reduced in preterm neonates with NEC in comparison to age-matched controls and serial citrulline determinations could help to monitor improvement of functional enterocyte mass during the course and resolution of NEC.     

Prevention and treatment of necrotising enterocolitis in preterm neonates

Prevention and treatment of NEC has become an area of priority for research due to the increasing number of preterm survivors at risk, and the significant mortality and morbidity related to the illness. Probiotic supplementation appears to be a promising option for primary prevention of NEC but further large trials are necessary for documenting their safety in terms of sepsis as well as long-term neurodevelopmental outcomes and immune function. As new frontiers including immunomodulating agents like pentoxifylline continue to be explored, the impact of well-established simple strategies like antenatal glucocorticoid therapy, and early and preferential use of breast milk must not be forgotten. Clinical research on manifestations of ileus of prematurity, and feeding in the presence of common risk factors such as IUGR is needed. Safety of minimal enteral feeds in terms of NEC and benefits of standardised feeding regimens need to be confirmed. Association of common clinical practices such as red cell transfusions, H2 receptor blockade, and thickening of feeds with NEC warrants attention. An approach utilising a package of potentially better practices seems to be the most appropriate strategy for the prevention and treatment of NEC.     

The effects of ibuprofen on sepsis parameters in preterm neonates

Aim

To examine the effects of ibuprofen used for patent ductus arteriosus (PDA) treatment on the production of the proinflammatory cytokines C-reactive protein (CRP) and interleukin 6 (IL-6) in preterm septic newborns.

Methods

Patients with acute phase reactant elevation were divided into two groups according to receiving ibuprofen (Group I, n = 51) or not (Group II, n = 38). Course of sepsis was evaluated by CRP and IL-6 levels.

Results

CRP and IL-6 levels at the time of diagnosis were not different between two groups [16 ± 9.1 vs 16.4 ± 13.2 mg/dL (p = 0.43) for CRP and 124 ± 82 vs 119 ± 73 mg/dL (p = 0.517) for IL-6, respectively]. Similarly, they were statistically insignificant between the groups at the 2nd or 3rd days of ibuprofen treatment [14.3 ± 7.7 vs 13.7 ± 5.9 mg/dL (p = 0.21) for CRP and 83 ± 46 vs 86 ± 37 mg/dL (p = 0.29) for IL-6, respectively]. However, CRP and IL6 levels showed significant difference between groups in the following days; 6.03 ± 3.8 vs 9.1 ± 4.9 mg/dL (p = 0.025) for CRP and 42 ± 33.1 vs 58.9 ± 27.1 mg/dL (0.011) for IL-6 on 4th or 5th days of treatment and 2.3 ± 3.2 vs 4.1 ± 2.3 mg/dL (p = 0.032) for CRP and 16.1 ± 12.4 vs 21.3 ± 16.8 mg/dL (p = 0.016) for IL-6, on 7th to 10th days of treatment, respectively.

Conclusions

IL-6 and CRP may decrease in infants receiving ibuprofen treatment more than infants who do not receive it. This decrease should be considered at the time of caring a preterm infant with both sepsis and PDA after ibuprofen treatment.     

Bovine lactoferrin supplementation for prevention of necrotizing enterocolitis in very-low-birth-weight neonates: a randomized clinical trial

ImportanceNEC is a common and severe complication in premature neonates, particularly those with very-low-birth-weight (VLBW, <1500 g at birth). Probiotics including lactobacillus rhamnosus GG (LGG) proved effective in preventing NEC in preterm infants in several RCTs.ObjectiveLactoferrin, a mammalian milk glycoprotein involved in innate immune host defences, can reduce the incidence of NEC in animal models, and its action is enhanced by LGG. We tried to assess whether bovine lactoferrin (BLF), alone or with the probiotic LGG, has a similar effect in human infants, something that has not yet been studied.DesignAn international, multicenter, randomized, double-blind, placebo-controlled trial conducted from October 1st, 2007 through July 31st, 2010.SettingThirteen Italian and New Zealand tertiary neonatal intensive care units.Participants743 VLBW neonates were assessed until discharge for development of NEC.InterventionInfants were randomly assigned to receive orally either BLF (100 mg/day) alone (group LF; n = 247) or with LGG (at 6×10⁹ CFU/day; group BLF + LGG; n = 238), or placebo (Control group; n = 258) from birth until day 30 of life (45 for neonates <1000 g at birth).Main outcome measures≥ stage 2 NEC; death-and/or-≥ stage 2 NEC prior to discharge.ResultsDemographics, clinical and management characteristics of the 3 groups were similar, including type of feeding and maternal milk intakes. NEC incidence was significantly lower in groups BLF and BLF + LGG [5/247 (2.0%)] and 0/238 (0%), respectively] than in controls [14/258 (5.4%)] (RR = 0.37; 95% CI: 0.136–1.005; p = 0.055 for BLF vs. control; RR = 0.00; p < 0.001 for BLF + LGG vs. control). The incidence of death-and/or-NEC was significantly lower in both treatment groups (4.0% and 3.8% in BLF and BLF + LGG vs. 10.1% in control; RR = 0.39; 95% CI: 0.19–0.80; p = 0.008. RR = 0.37; 95% CI: 0.18–0.77; p = 0.006, respectively). No adverse effects or intolerances to treatment occurred.Conclusions and relevanceCompared with placebo, BLF supplementation alone or in combination with LGG reduced the incidence of ≥ stage 2 NEC and of death-and/or ≥ stage 2 NEC in VLBW neonates. BLF might be a promising strategy to prevent NEC in NICU settings. Further data on larger sample sizes are warranted before BLF can be widespreadly used in clinical settings.Trial registrationISRCTN53107700–http://www.controlled-_trials.com/ISRCTN53107700.     

乳铁蛋白与早产儿坏死性小肠结肠炎

坏死性小肠结肠炎是早产儿常见主要并发症之一,具有较高的病死率和发病率,可以导致多种远期并发症,如短肠综合征、全身感染、眼部疾病、营养不良和神经系统发育障碍等.乳铁蛋白是母乳中的一种成分,具有抗细菌、抗病毒、抗真菌、增强免疫力等多种作用.新近许多研究评估了乳铁蛋白防治坏死性小肠结肠炎的效果和安全性.应用乳铁蛋白预防和治疗坏死性小肠结肠炎对于提高早产儿的预后具有很重要作用.     

脓毒症危重患儿非甲状腺疾病综合征的发生及其与IL-6和IL-10的相关性

目的 回顾性比较脓毒症与非脓毒症危重患儿非甲状腺疾病综合征（NTIS）的发生率,并初步探讨其发生与白细胞介素（IL）-6、IL-10的关系。方法 回顾性收集97例脓毒症患儿（脓毒症组）和80例细菌感染相关非脓毒症危重患儿（非脓毒症组）的基本资料及甲状腺功能检测结果进行分析研究,并将IL-6、IL-10与甲状腺功能指标三碘酪氨酸（T3）、四碘络氨酸（T4）、促甲状腺激素（TSH）进行相关性分析。结果 脓毒症与非脓毒症组年龄、性别比较差异无统计学意义（P > 0.05）。脓毒症组序贯器官衰竭评分、住院时间、呼吸机使用率等均高于非脓毒症组（P < 0.05）。脓毒症组炎症指标C反应蛋白（CRP）、降钙素原（PCT）、IL-6水平均显著高于非脓毒症组（P < 0.05）。脓毒症组甲状腺功能指标T3、T4、游离T3、游离T4、TSH水平均显著低于非脓毒症组（P < 0.05）。脓毒症组NTIS发生率、低T3低T4及低TSH发生率均显著高于非脓毒症组（P < 0.001）。相关分析发现脓毒症和非脓毒症患儿IL-6水平与T3、T4、TSH水平均无相关性（P > 0.05）,但两组患儿合并分析显示,IL-6水平与T3、T4水平均存在负相关关系（P < 0.001）。结论 脓毒症患儿相比非脓毒症危重患儿更容易合并NTIS,且高水平IL-6可能是造成NTIS发生的重要原因。     

Circulating interleukin-1 receptor antagonist levels in neonates

Abstract Circulating interleukin-1 receptor antagonist (IL-1 Ra) levels have been shown to reflect disease activity in certain conditions in adults. We determined circulating IL-1Ra references values for healthy neonates (healthy preterms and term infants with mild disease only) on days 2 (n=17) and 4 of life (n=23). Mean gestational age was 35±2.6 weeks. On the 2nd day of life IL 1-Ra levels were 0.78 ng/ml (0.49/2.65), on day 4 0.38 ng/ml (0.20/0.48) (median, 25th/75th percentile,P=0.01). The values were not influenced by gender. In neonates with severe illness (septicaemia, asphyxia, neonatal respiratory distress syndrome), who received invasive intensive care, circulating IL-1Ra levels were significantly higher than in the reference group of healthy newborns. On the 2nd day of life 14.72 ng/ml (4.38/18.67) versus 0.78 ng/ml (0.49/2.65),P<0.0001; on day 4 of life, 3.38 ng/ml (0.80/11.99) versus 0.38 ng/ml (0.20/0.48),P<0.005 (values are median; 25th/75th percentile, Mann-Whitney U-Wilcoxon Rank Sum W Test, two-tailedP).Conclusion Compared to healthy individuals beyond the neonatal period, IL-1Ra concentrations are physiologically elevated within the first days of life and decline to low levels within days. In contrast, IL-1Ra levels are strikingly elevated in sick neonates.     

Interleukin-3, interleukin-6, granulocyte-macrophage colony-stimulating factor and erythropoietin cord blood levels of preterm and term neonates

The cascade of known haematopoietic growth factors controlling granulomonopoiesis and erythropoiesis includes interleukin-3 (IL-3), interleukin-6 (IL-6), granulocyte-macrophage colony-stimulating factor (GM-CSF), and erythropoietin (EPO). Elevated endogenous IL-3 and IL-6 cord blood levels in infection-free premature and mature neonates may reflect their possible role for expansion of haematopoietic progenitor cells, granulocytes and monocytes. Within the erythroid lineage a synergistic action of IL-3, IL-6 and EPO can be assumed. To identify the regulatory role in fetal haematopoietic expansion cord blood plasma levels of these haematopoietic growth factors were assessed in 19 premature and 20 mature infants using commercial enzyme-linked immunosorbent assay and enzyme-amplified sensitivity immuno assay test kits. Peripheral blood IL-3, GM-CSF and EPO were studied in 5 and 10 premature infants respectively. Compared with cord blood levels we found a decline in EPO levels but no decrease of IL-3 and GM-CSF during the 1st month of life. We conclude that postnatal decrease in plasma burst-promoting activity levels in preterm infants is mainly explained by low postnatal EPO levels.     

IL-23受体和IL-17单核苷酸多态性与汉族早产儿坏死性小肠结肠炎的关系

目的 探讨白细胞介素-23受体（IL-23R）基因rs10889677位点、IL-17A基因rs2275913位点和IL-17F基因rs763780位点单核苷酸多态性（SNP）与汉族早产儿坏死性小肠结肠炎（NEC）的关系。方法 前瞻性选取2017年1月至2019年1月新生儿重症监护病房收治的100例汉族NEC早产儿为研究对象,其中Ⅱ期63例,Ⅲ期37例;另选取与NEC患儿胎龄、性别匹配的100例早产儿作为对照。采用PCR法和Sanger测序法鉴定rs10889677、rs2275913、rs763780位点的SNP。采用非条件logistic回归分析基因多态性与NEC易感性和病情严重程度的关系。结果 rs10889677位点、rs2275913位点基因型和等位基因频率对NEC发病无影响（P > 0.05）;rs763780位点基因型对NEC发病无影响（P > 0.05）,但C等位基因携带者相对于T等位基因携带者的NEC发病风险为1.652倍（95% CI：1.052~2.695,P < 0.05）。TC+CC基因携带者相对于TT基因携带者的NEC发病风险为1.856倍（95% CI：1.045~3.201,P < 0.05）。TC+CC基因携带者相对于TT基因携带者的NEC Ⅲ期的发生风险为2.965倍（95% CI：1.052~6.330,P < 0.05）;C等位基因携带者相对于T等位基因携带者的NEC Ⅲ期的发生风险为2.363倍（95% CI：1.034~4.093,P < 0.05）。结论 IL-23R基因rs10889677位点和IL-17A基因rs2275913位点SNP与汉族早产儿的NEC易感性无关,IL-17F基因rs763780位点TC+CC基因型和C等位基因与NEC易感性和NEC病情严重程度有关。     

Plasma concentrations of granulocyte-macrophage colony-stimulating factor and interleukin-6 in septic and healthy preterms

Plasma granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-6 (IL-6) concentrations were determined in 21 preterm infants with sepsis and nine healthy preterm neonates of the same postnatal age at sampling. Plasma GM-CSF levels were elevated at diagnosis in the septic preterms as compared to the healthy preterms (P = 0.01), but did not differ significantly on recovery. IL-6 levels were also elevated markedly at diagnosis (P = 0.0003), but decreased to normal on recovery as compared to the healthy preterm infants. GM-CSF levels were more prominent in septic preterms with neutropenia than those of non-neutropenic infants (P = 0.03). Conclusion Preterm infants can produce high levels of granulocyte-macrophage colony-stimulating factor and interleukin-6 in response to bacterial sepsis. Received: 11 March 1998 / Accepted: 27 July 1999     

Plasma cytokine levels in necrotizing enterocolitis

Plasma concentrations of tumour necrosis factor (TNF) and interleukin-6 (IL-6) were measured by ELISA in samples taken from 24 infants with necrotizing enterocolitis (NEC) between 0 and 306 h from diagnosis. TNF was detected (>10pg/ml) in 71% samples with a mean of 48pg/ml (95% CI 42 to 55 pg/ml) and did not vary with either time from diagnosis or severity of disease. IL-6 was raised during the first 48 h with a significant difference between stage II (mean 127 pg/ml, 95% CI 10 to 329 pg/ml) and stage HI (mean 3127 pg/ml, 95% CI 1809 to 4445 pg/ml, p = 0.001). Postoperative plasma IL-6 concentration fell to similar levels seen in stage II (mean 150 pg/ml, 95% CI 37 to 283 pg/ ml, p = 0.79). We conclude that plasma concentration of IL-6 rather than TNF reflects the clinical severity of necrotizing enterocolitis and that the relative level of these cytokines has important implications for the use of anti-cytokine therapy in NEC.     

脐血白细胞介素-6对早产儿脑损伤预后判断的价值

目的：探讨母亲的绒毛膜羊膜炎、脐血IL-6水平与早产儿脑损伤以及出生后3年间的神经系统后遗症之间的相互关系，了解临床检测脐血IL-6水平的意义，为及时诊断早产儿脑损伤、早期预防神经系统发育性障碍提供理论依据。方法：研究对象为26例早产儿。用ELISA方法检测早产儿脐血中IL-6水平；将母亲的胎膜组织行病理学检查，以诊断有无绒毛膜羊膜炎；早产儿生后3 d内行头颅超声或CT检查，以协助诊断有无脑损伤；随访早产儿出生后3年间的神经系统后遗症情况。结果：①有脑损伤的早产儿脑瘫、癫痫等神经系统发育性障碍的发生高于无脑损伤组；②母亲有绒毛膜羊膜炎组神经系统发育性障碍者增高；③有神经系统发育性障碍的早产儿的脐血IL-6水平明显高于无脑损伤组。结论：母亲的绒毛膜羊膜炎与早产儿脑损伤及其后发生的神经系统后遗症密切相关，故预防和积极治疗母亲的宫内感染对预防早产儿脑损伤以及降低脑瘫等严重神经系统后遗症的发病率均具有重要意义。脐血中的IL-6水平升高可能在母亲宫内感染导致早产儿发生脑损伤的过程中起重要的介导作用。     

幼年特发性关节炎白介素6、γ干扰素诱导蛋白10和白介素17的表达及意义

目的 研究幼年特发性关节炎(JIA)患儿外周血及关节液中白介素6(IL-6)、γ干扰素诱导蛋白10(IP-10)及白介素17(IL-17)的表达差异.方法 收集JIA患儿血清27例[其中全身型JIA (sJIA) 13例、多关节型JIA(pJIA) 14例]及关节液18例;疑诊sJIA患儿血清19例.另收集健康体检儿童血清28例作为对照.采用酶联免疫吸附法检测血清及关节液上清IL-6、IP-10及IL-17的浓度.结果 (1)血清细胞因子浓度:sJIA组血清IL-6浓度明显高于健康对照组[28.0(4.2 ～59.2)ng/L vs.12.3(2.1 ～ 13.8) ng/L,P＜0.05],但疑诊sJIA组与健康对照组相比无明显升高[11.8(7.7～39.2)ng/Lvs.12.3(2.1 ～13.8)ng/L,JP＞0.05].sJIA组血清IL-17浓度高于健康对照组[14.0(9.8～ 34.3)ng/L vs.9.8(7.9 ～ 16.2)ng/L,P＜0.05],pJIA组血清IL-17浓度与健康对照组相比无明显升高[14.2(9.9 ～ 16.9)ng/L vs.9.8(7.9 ～ 16.2)ng/L,P＞0.05].(2) sJIA及pJIA组关节液中IP-10的浓度均分别高于两组血清[619.7(160.9,873.1)ng/L vs.64.8(27.4 ～ 111.9) ng/L,P＜0.01;660.9(401.9,1349.8)ng/L vs.97.4(41.9 ～222.1)ng/L,P＜0.01].关节液中IL-17浓度仅pJIA组显著高于血清[22.9(17.1,45.8) ng/L vs.14.2(9.9 ～ 16.9)ng/L,P＜0.01].结论 (1)IL-6在sJIA发病中起重要作用,并且可能成为关节炎症早期的重要生物学标记.(2) sJIA发病机制中可能共同存在自身炎症反应和自身免疫反应.(3) IL-17在pJIA关节液局部高表达,而在外周血表达并不升高.(4)趋化因子IP-10在关节液和外周血中存在显著浓度梯度,可能是其发挥趋化作用,进而致sJIA关节损害的基础.     

T-tube ileostomy for intestinal perforation in extremely low birth weight neonates

To evaluate the results of use of T-tube ileostomy in selected cases of intestinal perforation in extremely low birth weight (ELBW) neonates. The records of 288 ELBW neonates treated at author’s institution, from 1998 to 2003 were retrospectively reviewed to identify neonates operated for intestinal perforation with T-tube placement. T-tube was inserted into the bowel through the site of perforation or proximally to the perforated gut via separate stab incision. T-tubes were used in five ELBW neonates (BW 600–900 g, gestational age 25–27 weeks) with intestinal perforation, in four of them at the time of primary surgery and in one neonate 8 days after primary anastomosis. All patients survived and there were no serious complications related to the T-tube insertion. Median duration of T-tube placement was 4 weeks (range 3–8 weeks), full enteral feeding after T-tube insertion was achieved in 4 weeks (range 1–6 weeks). All sites of T-tube insertion closed spontaneously. T-tube ileostomy is an effective and safe technique for treatment of selected cases of intestinal perforation in ELBW neonates. With respect to the hypoperistalsis of immature bowel, we recommend the use of T-tube in all cases of isolated intestinal perforation in ELWB neonates.     

Alternative female kangaroo care for procedural pain in preterm neonates: a pilot study

Aim: To determine the feasibility and effect size of kangaroo care (KC) for pain from heel lance in preterm neonates provided by either the infant’s mother (MKC) or an unrelated alternate female (AFKC). Methods: Using a randomized crossover design, preterm neonates (n = 18) between 28 and 37 weeks gestational age within 10 days of life from two university‐affiliated level III NICU’s undergoing routine heel lance were assigned to receive KC 30 min before and during the procedure from either their mother (MKC) or an unrelated woman. In the second heel lance procedure at least 24 h later but within 10 days, the infants were crossed over to the other condition. Results: There was a 48% participation rate, with only 40 of 82 eligible cases having maternal consent. The main reason for refusal was discomfort with another woman providing kangaroo care. The effect sizes on the pain scores (PIPP) were small, ranging from .23 to .43 across the first 2 min of procedure. Conclusion: The difference between nonrelated females and the mother in decreasing pain response is small, although not negligible. Given the high refusal rate, nonrelated females are a less desirable alternative to mothers than fathers.     

Different functional cardiac characteristics observed in term/preterm neonates by echocardiography and tissue doppler imaging

Background and aim

To establish, using echocardiography, color-flow Doppler and tissue doppler imaging (TDI), physiological values of systolic/diastolic indexes in healthy term/pre-term newborns, and to identify how different degrees of maturity influence morpho-functional cardiac alterations during the transitional period.

Study design and subjects

33 term newborns (M = 19, F = 14; gestational ages: 37th-41st week), and 20 pre-term infants (M = 11, F = 9; gestational ages: 31st-36th week) admitted to our department were studied. All infants underwent to clinical and Doppler ultrasound evaluations, carried out by the third to fourth day. Investigations included: M-mode echocardiography, color-flow Doppler and TDI.

Outcome measures and results

Term and preterm neonates differed for: interventricular septum and left systolic/diastolic ventricle diameters (p < 0.01 and < 0.05 respectively); left ventricle posterior wall in systole (p < 0.01); shortening and ejection fraction (p < 0.05). Color-flow Doppler parameters on the tricuspid (peak E, peak A, ratio E/A; p < 0.05) and on the mitral (peak E and E/A ratio; p < 0.01) significantly differed between the two groups. Significant differences were also present for basal left ventricular lateral wall and right ventricular lateral wall in the Ew (p < 0.01 and < 0.05 respectively), Sw peak (p < 0.01 and < 0.05 respectively), and Ew/Aw (p < 0.05). The isovolumetric relax time and the E/Ew measured on the medial mitral annulus also demonstrated significant differences (p < 0.01) between the two groups.

Conclusions

TDI is feasible in preterm neonates and enables assessment of myocardial velocities. With increasing gestational age, higher myocardial velocities and lower E/E′ Œ ratios were found. TDI addition to standard neonatal echocardiography may provide further important information about cardiac function.     

Comparison of the transcutaneous bilirubinometers BiliCheck and Minolta JM‐103 in preterm neonates

Aim: To investigate the trueness and uncertainty of two transcutaneous bilirubinometers BiliCheck and Minolta JM‐103 in preterm infants; establish cut‐off values for the transcutaneous bilirubin (TcB) level, indicating the need for total serum bilirubin (TsB) measurement; and estimate how many blood samples could be saved. Methods: In 133 neonates with gestational ages 28⁺⁰–34⁺⁶ weeks, 239 measurements of TcB by BiliCheck (TcB(B)) and JM‐103 (TcB(M)) and of TsB were performed. Results: Median TsB of the first samples was 160 (range, 53–293) μmol/L, whereas median TcB(B) was 12 μmol/L (8%) lower and TcB(M) 67 μmol/L (40%) lower. TcB(B) underestimated TsB for TsB ≥180μmol/L. All TcB(M) values, except one, underestimated TsB. The underestimation increased with increasing TsB. Multiple regression analysis showed that post‐natal age and ethnicity were confounding factors for TcB(M); none were found for TcB(B). The uncertainty was the same for the two instruments. By using cut‐off values of 70% of the phototherapy limit for TcB(B) and 35% for TcB(M), the sensitivity of the screening would be 95% and 97%, and 36% and 24% of the blood samples could be saved, respectively. Conclusion: TcB determined with JM‐103 gave values much lower than those obtained with BiliCheck. The underestimation of TsB increased with increasing concentrations. By using transcutaneous bilirubinometers in preterm neonates, 24–36% of the blood samples could be saved.     

IL-6和IL-8在诊断新生儿败血症中的价值研究

目的探讨白细胞介素-6(IL-6)、IL-8在新生儿败血症诊断中的临床价值。方法采用前瞻性研究设计,选取2014年8月至2015年2月患感染性疾病的新生儿共140例(败血症组49例,局部感染组91例)为研究对象,非感染性疾病的新生儿61例作为对照组,比较各组治疗前及治疗3 d后血清中IL-6和IL-8水平的差异,分析各指标诊断新生儿败血症的价值。结果治疗前败血症组IL-6、IL-8水平均高于局部感染组和对照组,IL-6和IL-8在局部感染组中水平均高于对照组(P0.05);治疗3 d后,败血症组IL-6水平均高于局部感染组和对照组,局部感染组IL-6水平高于对照组(P0.05),IL-8在各组间差异无统计学意义(P0.05)。治疗前ROC曲线分析显示:当IL-6取32 pg/m L时,敏感度、特异度和准确性分别为87.8%、79.6%、81.6%;当IL-8取54 pg/m L时,敏感度、特异度和准确性分别为77.6%、63.8%、67.2%;IL-6+IL-8联合诊断时,敏感度、特异度和准确性分别为71.4%、86.2%、82.6%。结论 IL-6、IL-8参与炎症反应,且两者水平与感染严重程度相关,IL-6诊断新生儿败血症的价值高于IL-8,且两者联合应用可提高新生儿败血症诊断的准确性。     

血浆IL-6与IL-27在鉴别早产儿急性呼吸窘迫综合征与呼吸窘迫综合征的初步研究北大核心CSCD

目的 探讨血浆白细胞介素(interleukin,IL)-6、IL-27在鉴别早产儿急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)及新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)中的价值。方法 前瞻性纳入2021年3~11月重庆医科大学附属儿童医院新生儿诊治中心具有呼吸窘迫表现的早产儿,根据诊断结果分为ARDS组(n=18)及NRDS组(n=20)。采用酶联免疫吸附试验法检测患儿血浆IL-6和IL-27水平,受试者工作特征(receiver operating characteristic,ROC)曲线分析各指标诊断ARDS的价值。结果 ARDS组血浆IL-6及IL-27水平均高于NRDS组(P<0.05)。ROC曲线分析显示:当IL-6取56.21 pg/m L时,曲线下面积、灵敏度和特异度分别为0.867、61.1%、95.0%;当IL-27取135.8 pg/m L时,曲线下面积、灵敏度和特异度分别为0.881、83.3%、80.0%。结论 血浆IL-6和IL-27可作为早期鉴别早产儿ARDS与NRDS的生物学指标。