Diagnosis of Neonatal Sepsis: The Role of Inflammatory Markers

Abstract

This is a narrative review on the role of biomarkers in the diagnosis of neonatal sepsis. We describe the difficulties to obtain standardized definitions in neonatal sepsis and discuss the limitations of published evidence of cut-off values and their sensitivities and specificities. Maternal risk factors influence the results of inflammatory markers as do gestational age, the time of sampling, the use of either cord blood or neonatal peripheral blood, and some non-infectious causes. Current evidence suggests that the use of promising diagnostic markers such as CD11b, CD64, IL-6, IL-8, PCT, and CRP, either alone or in combination, might enable clinicians discontinuing antibiotics confidently within 24–48 h. However, none of the current diagnostic markers is sensitive and specific enough to support the decision of withholding antibiotic treatment without considering clinical findings. It therefore seems to be justified that antibiotics are often initiated in ill term and especially preterm infants. Early markers like IL-6 and later markers like CRP are helpful in the diagnosis of neonatal sepsis considering the clinical aspect of the neonate, the gestational age, maternal risk factors and the time (age of the neonate regarding early-onset sepsis) of blood sampling.

Neonatal Early Onset Sepsis (EOS) Calculator plus Universal Serial Physical Examination (SPE): A Prospective Two-Step Implementation of a Neonatal EOS Prevention Protocol for Reduction of Sepsis Workup and Antibiotic Treatment

“…The categorical risk assessment, as the one applied in the first population (P1) of our study, is associated with a large number of infants undergoing laboratory evaluation [ 19 ]. Although numerous laboratory exams have been recommended over time for the diagnosis of EOS, they have shown to possess poor predictive values [ 20 ]: serial low WBC count and low absolute neutrophil count are associated with increased odds of infection, but normal values of these parameters do not possess enough sensitivity to rule out EOS in neonates [ 20 , 21 , 22 ]. CRP is not an effective selective EOS tool because it shows low sensitivity during the early phases of the disease and very low specificity.…”

The Presence of PDL-1 on CD8+ Lymphocytes Is Linked to Survival in Neonatal Sepsis

“…The clinical manifestation of neonatal sepsis is still complicated due to variable and non-specific symptoms, including the low sensitivity and specificity of traditional laboratory markers of inflammation. Currently, no single biomarker completely covers all criteria, leading to late diagnosis, while early treatment plays a crucial role in the outcome and prognosis [ 13 , 14 , 15 , 16 ].…”

Mesenchymal-Stem-Cell-Derived Extracellular Vesicles Attenuate Brain Injury in Escherichia coli Meningitis in Newborn Rats

“…Bacterial meningitis is caused by bacterial entry into the spinal cord and brain. Usually, initiation of an acute infectious/inflammatory response begins within 3 h, and peaks within 24 h [ 15 , 16 ]. However, the high mortality and resulting brain injury, such as neurological damage, are largely caused by the severe inflammatory response of the host against the bacteria [ 17 , 18 ].…”