Is Maternal Blood Procalcitonin Level a Reliable Predictor for Early Onset Neonatal Sepsis in Preterm Premature Rupture of Membranes?

Abstract

Background: This study is aimed at comparing the early diagnostic accuracy of maternal blood white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin in predicting early onset neonatal sepsis (EONS) among early preterm premature rupture of membrane (PPROM) pregnancies. Methods: A total of 57 consecutive pregnancies, complicated with PPROM, between 24 and 34 gestational weeks were recruited to the study at Suleymaniye Maternity Education and Research Hospital, Istanbul, Turkey between January 2012 and January 2013. All patients were hospitalized and followed up with expectant management. Maternal blood WBC count, CRP and procalcitonin levels were measured in the first 12 h of membrane rupture. EONS was diagnosed using clinical and laboratory findings, and obstetric and neonatal outcomes were noted. Results: The cutoff value for maternal blood CRP was ≥9.49 mg/dl. This value predicted EONS with 77.8% sensitivity, 80.0% specificity, 77.8% positive predictive value (PPV) and 80.0% negative predictive value (NPV). The cutoff value for maternal blood procalcitonin was 0.071 ng/ml. This value predicted EONS with 85.2% sensitivity, 86.7% specificity, 85.2% PPV and 86.7% NPV. Conclusion: Maternal blood procalcitonin levels were superior to maternal blood CRP and WBC count in predicting EONS. Consequently, the maternal blood procalcitonin level is a clinically useful, non-invasive and reliable biomarker in antenatal prediction of EONS.

Interleukin-6 as a Biomarker of Early-Onset Neonatal Sepsis

“…The retrospective aspect of the study was one limitation, in that we were limited to the revision of collected clinical data, unable to collect further studies during subject hospitalization. For example, it was not possible to evaluate the utility of other previously studied biomarkers in NS, such as procalcitonin, 1,22,23 as this paraclinical measurement is not ordered as a routine test in the HUHMP NICU. Similarly, routine laboratory work did not include peripheral blood smears for estimating immature and mature neutrophil counts, which have been previously shown to have diagnostic utility for NS.…”

“…►Supplementary Table 1 (available in the online version) shows the percentage of missing data for each variable. PCT and membrane rupture time were excluded due to the high percentage of missing data (>30% 1). None of the deliveries were assisted and none of the mothers had records of psychoactive drug use during pregnancy.…”

“…Neonatal sepsis (NS) remains one of the principal causes of neonatal morbimortality. 1 It has been reported that NS is the cause of up to 45% of neonatal intensive care unit (NICU) 2 deaths, claiming close to five million deaths annually. 3 NS is classified as early-onset NS (EONS) if symptoms manifest in the first 72 hours following birth, 4 or late-onset NS (LONS) if symptoms manifest after this period.…”

Establishment of reference intervals for maternal blood and umbilical cord blood procalcitonin in healthy Chinese women in late pregnancy

“…found that maternal blood PCT has higher specificity and positive predictive value in the detection of CA compared with CRP. Another study showed that maternal blood PCT is superior to CRP and WBC in predicting early‐onset neonatal sepsis (EONS) caused by CA . However, some researchers believe that maternal blood PCT cannot precisely predict CA .…”

Procalcitonin; a feasible biomarker for severe bacterial infections in Obstetrics and Gynecology?

“…High predictive value of PCT for early onset neonatal sepsis was found in another study. High maternal PCT predicted neonatal sepsis with >85% sensitivity, 87% specificity, 85% positive predictive value and 87% negative predictive value . However, reference values for PCT in pregnancy have not been established and PCT levels should always be considered on an individual patient level, taking in account the clinical condition of the patient.…”