Serum tumour necrosis factor in newborns at risk for infections

Tumour necrosis factor-α (TNF-α) is an important mediator in the pathogenesis of Gram-negative shock. In order to assess the role of TNF-α as a marker of the severity of infections in the neonates, serum TNF-α concentrations were determined at the time of septic work-up in 69 newborns (gestational age: 28–40 weeks). Nine patients had systemic infection (group A), four of them with signs of circulatory failure. Eleven patients had positive cultures of gastric aspiration or placental smears (group B) and 49 patients had completly negative septic work-up. Patients of group A had significantly more elevated serum TNF-α levels than patients of group B and C. Within group A, patients with circulatory failure had mean serum TNF-α concentration of 2165±817 pg/ml versus 27±8 pg/ml in newborns without shock. Serum TNF-α concentrations of more than 15 pg/ml detected systemic infections in eight out of nine patients. The specificity was 98% (1 elevated TNF-α concentration out of 60 non infected patients). These data indicate that premature neonates and term newborns are able to produce TNF-α when they are infected. Highly elevated TNF-α concentrations are found in severe systemic infections causing cardiovascular impairment.