Volume :
5
Issue :
1
Abstract :
Introduction Despite the advances in the critical care management, Health care associated infections (HAI) are leading to increased mortality and morbidity in Paediatric intensive care unit (PICU).Presently acquired immunity is measured routinely and not innate immune response. This study aims to measure Lipopolysaccharide (LPS) induced Tumour necrosis factor (TNF) α to determine innate immune response in sick children admitted to PICU and association with subsequent development of HAI. Materials and Methods A hospital based prospective and observational study was conducted wherein total of 63 children admitted to PICU requiring ventilation or indwelling central line for more than 2 days were included. Whole blood assay of TNF α levels using ELISA were measured after stimulation with Lipopolysaccharide on day 1,3 and 7 of ICU stay.Statistical analysis of the outcome variables was done by Mann Whitney U test and Wilcoxon signed rank test, ROC curve analysis for relation of TNF α with HAI and mortality Results TNF α is a significant predictor for HAI on day 1 estimation (p = 0.015). ROC curve showed Day 1 TNF α levels more than 247 pg/ml and Day 3 TNF α levels less than 203pg/ml as predictors of HAI and mortality respectively. There is statistically greater reduction in TNF α between Day 3-Day 7 than Day 1-Day 3 in non survivors (p=0.027). Children who had VAP (p=0.018), HAI (p=0.025), and such reduction was also present in children with HAI caused by multi drug resistant organisms (p=0.0047), gram negative organisms (p=0.0001) and MRSA (p=0.023). This reduction was absent in children who survived and did not develop HAI. Conclusion LPS induced TNF α levels are useful to predict likelihood of development HAI and mortality in critically ill children.