Association of tumour necrosis factor and haemodynamic shock in a newborn undergoing surgery for sacrococcygeal teratoma

A newborn who was operated upon for a benign sacrococcygeal teratoma at the age of 2 weeks developed haemodynamic instability with a shock episode at the time of operation. The serum level of tumour necrosis factor alpha (TNF-Alpha) during this event rose to 158 pg/ml (normal <15 pg/ml). Preoperatively TNF-Alpha was undetectable, while post-operatively the level was 23 pg/ml. Serum levels of the cytokine interleukin-1 beta (IL-1 beta) were undetectable throughout the study. The baby was treated successfully by fluid challenge and dopamine. This case represents a temporal association between haemodynamic instability during surgical intervention and a high serum level of TNF-Alpha, which is an important mediator in the pathogenesis of septic shock.