Abstract
Introduction: Aim of this study was to determine the kinetics of procalcitonin (PCT), interleukin-6
(IL-6), interleukin-8 (IL-8) and C-reactive protein (CRP) serum concentrations after
different types of neonatal surgery.
Material and methods: We conducted a prospective, observational study in a level III multidisciplinary
neonatal intensive care unit. We enrolled twenty-five (n=25) neonates undergoing major
surgery (for gastroschisis, atresia of the small intestine, congenital diaphragmatic
hernia, esophageal atresia, coarctation of the aorta, neurosurgical procedures). Serum
PCT, IL-6, IL-8 and CRP were measured before surgery, immediately after surgery (POD
0) and on the first and second day after surgery (POD 1, 2).
Results: Median preoperative serum concentrations were: PCT 1.3 μg/l, IL-6 985 fmol/l, IL-8
51 pg/ml, CRP 6 mg/l. PCT increased insignificantly after surgery with a peak median
concentration on POD 1 (2.0 μg/l), but concentrations varied considerably between
patients in the same category of surgery. IL-6 significantly increased on POD 0 (median
2 262 fmol/l), with a peak median concentration on POD 1 (3 410 fmol/l), and decreased
thereafter. IL-8 increased significantly after surgery with a peak median concentration
on POD 0 (125 pg/ml) and decreased thereafter. IL-8 response was very consistent after
all types of surgery. CRP only began to increase on POD 1 (median 20 mg/l) with a
peak median concentration on POD 2 (21 mg/l).
Conclusions: The physiological increase in PCT after birth and the impact of underlying disease
make the interpretation of postoperative values in the immediate postnatal period
difficult. IL-6 is a very sensitive marker of neonatal surgical injury with considerable
variation between different types of surgery. IL-8 response after neonatal surgery
is similar after all types of surgery, very rapid and transient with relatively low
concentrations. CRP response to surgery is slow with persistence of elevated levels
throughout the study period. IL-8 could potentially be a useful marker for monitoring
infection in the immediate postoperative period in neonates.
Key words
neonates - surgery - inflammatory markers - procalcitonin - interleukin-8
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Correspondence
Dr. Maja Pavcnik-Arnol
University Medical Center
Ljubljana
Department of Pediatric
Surgery and Intensive Care
Bohoriceva 20
1000 Ljubljana
Slovenia
Phone: + 386 31 342 914
Fax: + 386 1 430 17 14
Email: maja.pavcnik@kclj.si