Cytokines – markers of the early neonatal infections

Neonatalperiodisthetimewhenchildrenareextremelyvulnerableandsusceptibletolethalinfectious complications that could be prevented due to early diagnostic procedures and adequate therapy. Problems with early clinical diagnostics determine the need for searching a marker which could help to differentiate newborn with infection from the newborn with perinatal symptoms resembling infection. Blood microbiological testing frequently gives false negative results, and newborn blood culture tests have low sensitivity. Molecular methods, especially PCR, have also moderate diagnostic accuracy, and can not replace bacteriological blood testing as a reference standard. The same problems exist with C-reactive protein and procalcitonin determination. Ideal marker’s level must quickly rise after contact with pathogen prior to clinical symptoms onset and also quickly decrease after infection healing having high sensitivity and specificity. Cytokines are one of the markers for the infectious process beginning. These molecules are among first to be synthesized after bacterial recognition by pattern-recognition receptors. Their blood plasma concentrations significantly increase during first hours after antiinfectious immune response beginning. That is why cytokines levels determination during neonatal infections may serve as significant tool for early diagnostics and adequate choice for treatment strategy. In this review we tried to summarize existing data on cytokine levels in newborns with neonatal infections and sepsis, and data on its significance in diagnostic approaches. Studies on cytokine levels in newborns are few in number, and reference concentrations are not yet determined. Cytokine family consists of hundreds of molecules, most of them are important mediators of inflammation and sepsis. However not all of them are studied for blood level changes during severe infections in neonatal period. Probably simultaneous studies of several cytokine levels and their synthesis ratio could give new informative data for early neonatal infection diagnostics improvement.

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