Amniotic fluid granulocyte colony stimulating factor levels in chorioamnionitis do not predict neonatal sepsis

Relationship between the neonatal white blood cell count and histologic chorioamnionitis in preterm newborns

OBJECTIVE

The aim was to examine the relationship between neonatal white blood cell (WBC) count and the diagnosis of histologic chorioamnionitis (HCA).

DESIGN

We measured WBC, a widely used marker of inflammation, to evaluate whether the values at birth were associated with HCA.

SETTING

NICU, Department of Pediatrics of Padua University, Padua, Italy.

SUBJECTS

WBC count was evaluated in 71 preterm neonates (<32 weeks of gestation) with HCA and in a control group without HCA on day 1, 3, and 6 after delivery. Logistic regression analysis and diagnostic accuracy analysis were used to assess the association between WBC counts and HCA.

MAIN RESULTS

WBC levels were significantly higher in infants with HCA than in those without HCA (Median IQR, WBC (x10(9)/l): day 1, 13.2 (6.2-21.8) vs 8.1 (6-11.4), p < 0.001; day 3, 17.4 (11.4-26.9) vs 6.3 (5.2-8.3), p < 0.001; day 6, 18.4 (11.1-31) vs 6.5 (4.4-9), p < 0.0001). The neonatal WBC count on the third day of life was the most sensitive parameter associated with HCA (sensitivity: 0.80; specificity: 0.88). The cut-off value based on the ROC curve was 10 (x10(9)/l).

CONCLUSIONS

WBC count in the third day of life is strongly associated with HCA.

Human developmental biology of granulocyte colony-stimulating factor

The availability of granulocyte colony-stimulating factor (G-CSF) has influenced the management of neonates with neutropenia. Since the first use of G-CSF in a neonate with neutropenia, much has been learned about the cellular sources and physiologic roles of G-CSF. This article reviews our present understanding of G-CSF and its cognate receptor in the fetus and neonate.

Neoteric physiologic and immunologic methods for assessing early-onset neonatal sepsis

Septicemia is a growing problem among low birth weight infants. Early identification and treatment of sepsis in these infants would help to reduce the high mortality and morbidity seen with this disorder. Newer techniques may make earlier diagnosis a reality. In the following review article, early-onset sepsis in the premature infant is described, specifically focusing on the neonatal inflammatory response, neutropenia, and its somewhat inconsistent and delayed role as a marker for sepsis risk factors. Physiological signs, laboratory indicators, skin temperature, peripheral perfusion, and the interaction of macro-environmental factors are also discussed. Newer (neoteric) immunologic and cytokine markers of sepsis are reviewed. Finally, thermography, a noninvasive bioinstrument measuring vasoactive peripheral perfusion, which has potential for early recognition of neonatal septicemia, is described.