临床儿科学：开放获取
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Differential Expression of Tumor Necrosis Factor-Related Apoptosis Inducing Ligand (TNF-TRAIL) and Interferon-gamma Inducible Protein (IP-10) Biomarker Levels in Neonatal Infections: Potential Role in Ruling out Bacterial Infections to Promote Antibiotic Stewardship

Deema Arow Zahalka

Background: Fever is the most common cause for neonates visiting the Emergency Room (ER). Because bacterial versus viral infection symptoms exhibited by neonates are similar, clinical assessment and history taking are usually insufficient to distinguish etiology, even for experienced doctors. This clinical uncertainty drives antibiotic misuse, unwarranted invasive diagnostic procedures and longer hospitalizations.

Methods: A prospective study conducted at Hillel Yaffe Medical Center from 2019 to 2021 to investigate the expression of three serum proteins: Tumor Necrosis Factor-Related Apoptosis Inducing Ligand (TNF-TRAIL), interferon gamma-Induced Protein-10 (IP-10) and C-Reactive Protein (CRP) in neonates up to three months of age with microbiologically confirmed bacterial infections versus viral infection.

Results: Out of 107 infants, 94 had sufficient serum for measuring the biomarkers. Of these, 85 had febrile illness, of which 12 had microbiologically confirmed bacterial disease and 73 viral diseases. Mean age for both groups was 44 days old. Neonates with bacterial infections exhibited lower levels of TRAIL (p<0.05) and IP-10 (p=0.18) and higher levels of CRP (p<0.05). IP-10 levels > 1100 pg/ml were only observed in non-bacterial infected neonates.

Conclusions: There are significant differences in IP-10, TRAIL and CRP expression levels in response to bacterial versus viral infection in neonates. A prognosis based on these biomarkers can potentially improve the management of neonates with fever, by aiding in the differentiation between bacterial and viral disease, thereby reducing unnecessary work-ups and treatments.