PubMed · 8716256
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A Bitterklee. 1996. [Very young autonomy].. https://pubmed.ncbi.nlm.nih.gov/8716256/
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BACKGROUND: Neonatal sepsis is a common and life-threatening disorder, particularly among preterm infants. Early initiation of antibiotic therapy is frequently delayed because the first clinical signs of sepsis are non-specific and there are no reliable early laboratory indicators. We investigated the time course of expression and the prognostic power of the early inflammatory mediators interleukin-1 receptor antagonist (IL-1ra), interleukin-6 (IL-6), and circulating intercellular adhesion molecule-1 (cICAM-1) before clinical diagnosis of sepsis. METHODS: In a prospective multicentre study, we monitored 182 very-low-birthweight infants in six intensive-care units for occurrence of sepsis. During routine or clinically indicated blood sampling, an additional sample was collected for measurement of IL-1ra, IL-6, cICAM-1, and C-reactive protein (CRP). Infants were grouped into those with proven sepsis, no infection, or unclassified. The mean study duration was 34 days. Whenever sepsis occurred, a study period of 10 days was defined: day 0 was the day of clinical diagnosis of sepsis; days -4 to -1 were the 4 days before diagnosis; days +1 to +5 were the 5 days after. We compared the concentrations of the immune mediators during the 10-day study period with group-specific baseline values from before day -4. FINDINGS: 101 infants were included in the analysis: 21 with proven sepsis, 20 with no infection, and 60 unclassified. We excluded 57 because of incomplete datasets and 24 who had early-onset sepsis. IL-1ra and IL-6 increased significantly 2 days before diagnosis of sepsis; maximum median increases within the study period were 15-fold for IL-1ra and 12-fold for IL-6. The diagnostic sensitivities of IL-1ra, IL-6, and CRP concentrations on day 0 of diagnosis were 93%, 86%, and 43%, respectively; corresponding values on day -1 were 64%, 57%, and 18%. The specificities of IL-1ra, IL-6, and CRP concentrations were 92%, 83%, and 93%. cICAM-1 had a specificity of only 64%. INTERPRETATION: IL-1ra and IL-6 are superior to cICAM-1 and CRP as predictors of sepsis 1 or more days before clinical diagnosis. Ad-hoc measurement of these cytokines could allow earlier initiation of antibiotic therapy with corresponding improvement in outcome in very-low-birthweight infants with sepsis.
When Sigmund Freud was taken ill in 1923 with a malignant tumor of his right upper jaw he was initially treated by the famous Viennese rhino-laryngologist, Professor Markus Hajek. One year later, Franz Kafka, who was suffering from pulmonary tuberculosis which had spread to the larynx, was likewise placed under the care of this distinguished specialist. Neither of the encounters proved beneficial from the professional point of view and both well-known patients received remarkably poor attentions in keeping with the general autocratic attitude by clinical chiefs of the time in Vienna. Franz Kafka was terminally ill when he came to Hajek and no treatment was yet available for the disabling and painful laryngeal complication of his advanced tuberculosis. He died about a month after leaving Hajek's ward in Vienna. Sigmund Freud required repeated subsequent operations on his jaw and the insertion of a prothesis. Hajek had handed Freud over to Hans Pichler for further care and it was entirely due to the skill of this extremely competent and empathetic maxilliary surgeon that Freud lived for another 16 years, working to almost full capacity.
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