ABSTRACT. Objective. To evaluate the diagnostic value of peripheral circulatory reactive hyperemia and serum levels of interleukin-6 (IL-6), IL-8, and tumor necrosis factor-␣ (TNF-␣) in early-onset neonatal sepsis.Methods. Reactive hyperemia in the dorsal hand and serum levels of IL-6, IL-8, and TNF-␣ were studied in newborn infants (n ؍ 32; gestational age 39 ؎ 3 weeks) who had been admitted to the neonatal unit because of suspected sepsis <48 hours after birth. On admission, reactive hyperemia after a standardized arterial occlusion was measured with laser Doppler technique, and blood samples were taken for cytokine analyses. On the basis of predetermined criteria, the infants subsequently were classified as septic (n ؍ 12) or not (n ؍ 20).Results. The degree of reactive hyperemia was higher in the group with sepsis (median ؉ 170% perfusion increase) than in that without (؉37%). On admission, serum levels of IL-6, IL-8, and TNF-␣ all were higher in septic (median values: 1620, 331, and 22 pg/mL, respectively) than in nonseptic neonates (median values: 42, 63, and 13 pg/mL, respectively). In the group with sepsis, the degree of reactive hyperemia correlated to log IL-6 (r ؍ 0.80) and log IL-8 values (r ؍ 0.71).Conclusion. Newborn infants with septicemia have increased reactive hyperemia and elevated cytokine levels very early in their disease. Reactive hyperemia in skin can be analyzed at the bedside and noninvasively and therefore may serve as an additional diagnostic tool in neonatal sepsis. Pediatrics 2001;108(4). URL: http://www. pediatrics.org/cgi/content/full/108/4/e61; neonatal sepsis, newborn infant, interleukin-6, interleukin-8, TNF-␣, reactive hyperemia, diagnostic marker.ABBREVIATIONS. CRP, C-reactive protein; WBC, white blood cell count; IL-6, interleukin 6; TNF-␣, tumor necrosis factor-␣; IL-8, interleukin 8; LD, laser Doppler; PPV, positive predictive value; NPV, negative predictive value; ROC, receiver-operating characteristic curve; RDS, respiratory distress syndrome; GBS, group B streptococci. S erious infections are still causing significant morbidity and mortality among newly born infants. Immediately after birth, the clinical picture of neonatal sepsis is difficult to distinguish from more benign conditions. Rapid and reliable diagnostic tools are not yet available at the bedside. Because a delay in instituting antibiotic therapy may have adverse consequences in cases of true neonatal sepsis, in many cases decisions to treat are based on risk factors and nonspecific signs and symptoms.Experienced neonatologists and nurses recognize that in infants with sepsis, a poor peripheral circulation with a gray skin color often precedes more alarming symptoms, such as arterial hypotension and circulatory failure. Specific deviations in peripheral vascular reactivity have been found in late neonatal sepsis, 1 even before traditional markers, such as C-reactive protein (CRP) elevation and changes in white blood cell count (WBC) in peripheral blood, indicate serious infection. The advantages of...