Prognostic Value Of Cytokine Measurement In Blood And CSF In Asphyxia Newborns

Perinatal asphyxia and secondary hypoxic-ischemic encephalopathy (HIE) are common disease of neonatal period and often cause death and neurological impairment. Previous studies showed that cytokines are related to brain damage and the neurological outcome after hypoxia-ischemia. It indicates that the immune-inflammatory system participates in the pathophysiological course of HIE. Erythropoietin (Epo), functions as a tissue-protective cytokine in addition to its crucial hormonal role in red cell production. There were no detail reports about the relationship of dynamic measurement of cytokines in blood and CSF and prognosis in asphyxia neonates. In this study, cytokines including tumor necrosis factor-alpha (TNF-α ), interleukin-6 (IL-6), interleukin-8 (IL-8) and EPO were measured at 1, 3 and 5 days after birth both in blood and CSF in 63 cases asphyxiated term infant and compared blood measurement with that of 22 cases normal control. The correlation of cytokines and prognosis was evaluated at 6 moths after birth by CDCC. Objects1. Asphyxia group: 63 cases full-term asphyxia infant were classified into 2 groups (14 cases without HIE, 49 cases with HIE) according to the signs of encephalopathy. 49 cases infant with HIE were classified into 3 groups (20 cases in mild degree, 16 cases in moderate degree and 13 cases in severe degree) according to the' Criteria of clinical diagnosis and classification for neonatal hypoxic-ischemicencephalopathy' which was formulated at the Hangzhou meeting in 1996.2. Control group: 22 cases normal full-term infants. There was no significant deference in sex, gestational age, and birth weight among the groups. Methods1. Sample preparation: 3 ml blood was taken out from the thigh vein at 9 Am in the 1st day, 3 rd day and 5th day after birth. The sample was spun at 4 4000 rpm for 10min and supernatant (serum) was aliquot and frozen at -70 2 ml cerebrospinal fluid (CSF) was taken by lumbar puncture from asphyxia infants in the same day and the procedure for the preparation of CSF sample was same as blood sample. The concentration of TNF-α, IL-6, IL-8, and EPO in serum and CSF were measured by radioimmunoassay. The kits for the radioimmunoassay were from Immunological Research Institute of PLA General Hospital.2. Follow up of neurological development: Neurological development was evaluated by' CDCC 'method when the infants were 6 months. The results were including Mental Developmental Index (MDI) and Psych-motor Developmental Index (PDI). The criteria of judgment: normal >80, suspicious 70-79, abnormal <69.3. The data were expressed as mean ?SD. Analysis of variance, t test, nonparametric test, and linear correlation were done by SPSS 10.0 software. Results1. The serum concentration of TNF-α was higher in asphyxiated newborn than that of in control, and it correlated with the degree of HIE. The level of serum TNF-α was highest at the 1 st day and decreased after that. The concentration of TNF-α in CSF was higher in the newborn with HIE than that of without HIE. There was no dramatic change after birth in CSF.2. The serum concentration of IL-6 was higher in newborn with HIE than that of without HIE and in normal control. The serum level of IL-6 was highest in the 3rd day. The concentration in CSF was much higher in the newborn with HIE than that of without HIE. It was highest in severe HIE group. The dynamic changes of IL-6 in CSF were similar in serum and they were positive correlated.3. The concentration of IL-8 in serum was higher in asphyxiated newborn thanthat of in control. But there was no significant difference among the asphyxiated groups in the 1st day. There was no marked dynamic change within five days. The levels of IL-8 in CSF were much higher in moderate and severe HIE groups than that of in mild HIE and without HIE groups. The concentration of IL-8 decreased within 5 days after birth.4. The concentration of EPO in serum was higher in asphyxiated newborn than that of in control infant. However, the leve...