Ip10 Levels are Negative Predictive Value for Bacterial Infection in Neonates ( 0-90 days )

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

Method: A prospective study conducted at Hillel Yaffe Hospital from 2019 to 2021 to investigate expression of 3 host proteins – TRAIL, IP-10 and CRP – in neonates up to 3 months of age with microbiologically confirmed bacterial infection versus suspected viral infection.

Result: Out of 107 infants, 94 had sufficient serum for measuring the biomarkers. Of these, 85 infants had febrile illness, of which 12 had microbiologically confirmed bacterial disease (‘bacterial’) and 73 suspected viral disease (‘non-bacterial’). Mean age for both groups was 44 days old. Neonates with bacterial infection 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 observed only in non-bacterial neonates.

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