Predictive value of plasma and cerebrospinal fluid tumour necrosis factor-alpha and interleukin-1 beta concentrations on outcome of full term infants with hypoxic-ischaemic encephalopathy.

AIM—To determine the predictive value of plasma and cerebrospinal fluid (CSF) tumour necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) concentrations on the outcome of hypoxic-ischaemic encephalopathy (HIE) in full term infants. METHODS—Thirty term infants with HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat. Blood and CSF were obtained within the first 24 hours of life and stored until assay. Five infants died soon after hypoxic insult. Neurological examinations and Denver Developmental Screening Test (DDST) were performed at 12 months in the survivors. RESULTS—At the age of 12 months neurological examination and DDST showed that 11 infants were normal; 14 had abnormal neurological findings and/or an abnormal DDST result. Eleven normal infants were classified as group 1 and 19 infants (14 with abnormal neurological findings and/or an abnormal DDST and five who died) as group 2.CSF IL-1β and TNF-α concentrations in group 2 were significantly higher than those in group 1. Plasma IL-1β and TNF-α concentrations were not significantly different between the two groups. IL-1β, but not TNF-α concentrations, in group 2 were even higher than those in group 1, although non-survivors were excluded from group 2. When the patients were evaluated according to the stages of Sarnat, the difference in the three groups was again significant. Patients whose CSF samples were taken within 6 hours of the hypoxic insult had higher IL-1β and TNF-α concentrations than the patients whose samples were taken after 6hours. CONCLUSIONS—Both cytokines probably contribute to the damage sustained by the central nervous system after hypoxic insult. IL-1β seems to be a better predictor of HIE than TNF-α.