The Assessment of Soluble Toll-like Receptors Type 2 in a Group of ELBW Infants with Early and Late Onset Sepsis

Background: Imperfect innate immune response in infants born with body weight less than 1000 grams leads to high incidence of neonatal sepsis. Overexpression of Toll-like reseptors type 2 (TLR2) may play a significant role in determination and prediction of the severity of septic procces and it`s outcomes.

Objective: Evaluation of TLR2 in the blood of extremely low birth weight (ELBW) neonates with early and late onset bacterial sepsis. Both survivals and non-survivals of sepsis were included.

Methods: The study included 48 premature neonates born weighting less than 1000 grams with geastational age ≤ 28 weeks. The levels of TLR2 were evaluated on the 3^rd, 7^th and 14^th days of life and than repeated at 35-36 weeks (before discharge) of postmenstrual age for survivals.

Results: 79% of infants had early onset sepsis (EOS), 21% had late onset sepsis (LOS). 31% of all neonates with sepsis died. There was no signifacant difference of the levels of TLR2 in EOS and LOS groups. The significant difference was found between groups of survivals and non-survivals: in non-survivals TLR2 level was 8-10 times higher and had no tendency to decrease up to the 14^th day of life. Infants with the TLR2 levels ≥ 4,2 ng/ml on the day 3, 7 were at 16,4 times increased risk (Cl [7.2;33,8]) and had 54,4 times greater odds (Cl [12.2;133,8]) of death in the neonatal period, p<0.01.

Conclusion: TLR2 levels could be used as significator of innate imune insufficiency and predictor of neonatal death in extremly preterm infants with neonatal sepsis.