Elsevier

The Journal of Pediatrics

Volume 137, Issue 3, September 2000, Pages 345-350
The Journal of Pediatrics

Original Articles
Premature infants respond to early-onset and late-onset sepsis with leukocyte activation

https://doi.org/10.1067/mpd.2000.107846Get rights and content

Abstract

Objective: Leukocyte differentiation antigens are expressed on the cell membrane during activation. The purpose of this study was to evaluate leukocyte activation in premature neonates with sepsis. Paired blood samples from the same individual while sick and while convalescent were examined to quantify the expression of leukocyte antigens in these clinical states. Methods: Mononuclear blood cells from 21 premature infants (24 to 30 weeks’ gestation) were analyzed. The “sick” samples were drawn at the time of workup for sepsis; “convalescent” samples were drawn 20 days later. Samples were incubated with monoclonal antibodies to the lymphocyte antigens CD3, CD19, CD25, CD26, CD71, and CD69 and neutrophil antigens CD11b, CD11c, CD13, CD15, CD33, and CD66b. The cells were lysed, fixed, and analyzed by flow cytometry. Results: Twenty-one infants enrolled in the study had multiple sepsis evaluations and had more than one sample available for a paired observation. CD33, CD66b, and CD19 levels were significantly elevated in both the presumed sepsis and culture-proven sepsis groups when compared with the samples drawn from those same patients when healthy. Expression of CD33 and expression of CD66b were correlated, and in a multivariate analysis the elevation of antigen expression was predictive of sepsis. Conclusions: Leukocytes from preterm newborn infants respond to infection with an increased expression of CD19, CD33, and CD66b on their cell surfaces. (J Pediatr 2000;137:345-50)

Section snippets

METHODS

The study was approved by the New England Medical Center Human Investigation Review Committee. Verbal consent was obtained after a statement of participation was read to the parents. The sample of blood was the blood remaining in the tubing and syringe at the time a clinical blood sample was obtained for analysis.

Study Population

Twenty-one infants enrolled in the study had multiple sepsis evaluations and had more than one sample available for a paired observation. Of note, 5 individual infants had 3 different samples obtained that were assigned at different times to each clinical group. The median gestational age of the infants was 25 weeks (range, 24-30 weeks). The median birth weight was 762 g (range, 854-1295 g); 16 infants (76%) were male. There were 8 (38%) vaginal deliveries and 13 (62%) cesarean sections. The

DISCUSSION

The tests currently used to diagnose bacterial sepsis are neither sensitive nor specific in the neonatal period. Manroe et al6 described reference ranges for neonatal neutrophil counts in both healthy infants and infants with sepsis. In this large study, neutropenia and an immature to total neutrophil ratio >0.16 were the most informative in predicting sepsis. However, the neutrophil count and an immature to total neutrophil ratio had a sensitivity of only 77% and 50%, respectively, and the

References (17)

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Reprint requests: Diana W. Bianchi, MD, Division of Newborn Medicine, New England Medical Center, 750 Washington St, Box No. 394, Boston, MA 02111.

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