Distinct cytokine patterns may regulate the severity of neonatal asphyxia-an observational study

Background: neuroinflammation and a systemic inflammatory reaction are important features of perinatal asphyxia. neuroinflammation may have dual aspects being a hindrance,but also a significant help in the recovery of the cns. we aimed to assess intracellular cytokine levels of t-lymphocytes and plasma cytokine levels in moderate and severe asphyxia in order to identify players of the inflammatory response that may influence patient outcome. methods: we analyzed the data of 28 term neonates requiring moderate systemic hypothermia in a single-center observational study. blood samples were collected between 3 and 6 h of life,at 24 h,72 h,1 week,and 1 month of life. neonates were divided into a moderate (n=17) and a severe (n=11) group based on neuroradiological and amplitude-integrated eeg characteristics. peripheral blood mononuclear cells were assessed with flow cytometry. cytokine plasma levels were measured using bioplex immunoassays. components of the kynurenine pathway were assessed by high-performance liquid chromatography. results: the prevalence and extravasation of il-1b + cd4 cells were higher in severe than in moderate asphyxia at 6 h. based on receiver operator curve analysis,the assessment of the prevalence of cd4+ il-1β+ and cd4+ il-1β+ cd49d+ cells at 6 h appears to be able to predict the severity of the insult at an early stage in asphyxia. intracellular levels of tnf-α in cd4 cells were increased at all time points compared to 6 h in both groups. at 1 month,intracellular levels of tnf-α were higher in the severe group. plasma il-6 levels were higher at 1 week in the severe group and decreased by 1 month in the moderate group. intracellular levels of il-6 peaked at 24 h in both groups. intracellular tgf-β levels were increased from 24 h onwards in the moderate group. conclusions: il-1β and il-6 appear to play a key role in the early events of the inflammatory response,while tnf-α seems to be responsible for prolonged neuroinflammation,potentially contributing to a worse outcome. the assessment of the prevalence of cd4+ il-1β+ and cd4+ il-1β+ cd49d+ cells at 6 h appears to be able to predict the severity of the insult at an early stage in asphyxia. © 2017 the author(s).