The role of Rotavirus infection in necrotising enterocolitis and potential association with cytokins

Purpose: To evaluate the role of Rotavirus infection and asociation with interleukin 6, interleukin 8 and tumour necrosis factor alpha in the pathogenesis of necrotising enterocolitis.Materials and Methods: The study group (Group 1) included patients who were followed-up with the suspect or diagnosis of necrotising enterocolitis at University of Çukurova School of Medicine, Newborn Intensive Care Unit. A control group (Group 2) was formed with neonates of similar postnatal age, hospitalized for other reasons. Necrotising enterokolitis cases were staged according to modified Bell?s criteria. Stool samples were tested with Latex agglutination for Rotavirus antigen. Micro ELISA test was used for detection of interleukin 6, 8 and tumour necrosis factor alpha in the serum, obtained at initial diagnosis and 48 hours following diagnosis. Both groups were compared by means of clinical and laboratory features.Results: Thirty one patients with necrotising enterocolitis and 30 control patients were prospectively analyzed. No significant difference between groups by means of gender, intrauterine growth and birth weight was detected. In necrotising enterocolitis cases, gestational age was significantly lower and hospital stay was significantly longer (p=0.031 and p=0.007, respectively). Rotavirus was detected in 41.9% of necrotising enterocolitis patients and 6.7% of controls (p=0.001). The risk of necrotising enterocolitis increased 10 times by Rotavirus infection. Of Rotavirus positive patients in Group 1, 35.5% had stage I, 54.8% had stage II, and 9.7% had stage III necrotising enterocolitis. Interleukin 6 values of Group 1 patients at initial and 48 hours, were lower than the values of the Group 2 patients (p=0.448 and p=0.016 respectively). In Rotavirus positive necrotising enterocolitis patiens, interleukin 6 at initial and 48 hours were lower than Rotavirus negative necrotising enterocolitis patients (p=0.609 and p=0.017 respectively). Initial and 48 hours values of interleukin 8 were significantly higher in Group 1 than Group 2 (p=0.000 and p=0.023 respectively). In Rotavirus positive necrotising enterocolitis patiens, interleukin 8 at initial and 48 hours were significantly higher than Rotavirus negative necrotising enterocolitis patients (p=0.007 and p=0.004 respectively). Tumour necrosis factor alpha values of Group 1 patients at initial and 48 hours, were higer than the values of the Group 2 patients (p=0.516 and p=0.048 respectively). In necrotising enterokolitis patients, for tumour necrosis factor alpha, both initial values and 48 hours values were higher in Rotavirus positive cases than Rotavirus negative cases (p=0.352, p=0.880 respectively).Conclusions: Necrotising enterocolitis is a common cause of mortality and morbidity in preterm infants. In Rotavirus associated decrease in IL 6 and the increase in IL 8 and TNF-?, shows that Rotavirus can play a major role in the pathogenesis of the disease. Besides Rotavirus associated necrotising enterocolitis cases have better prognosis, prevention for the virus that can cause epidemies, will provide an important contribution for enhanced survival at newborn intensive care units.