Umbilical cord blood procalcitonin and C reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection

Abstract

Procalcitonin (PCT) and C reactive protein (CRP) concentrations in umbilical cord blood of 197 neonates were measured to evaluate their value as markers of infection. Sixteen of the neonates were infected. The sensitivity, specificity, and negative and positive predictive values were respectively 87.5%, 98.7%, 87.5%, and 98.7% for PCT and 50%, 97%, 67%, and 94% for CRP. Serum PCT in cord blood seems to be a useful and early marker of antenatal infection.M aternofetal bacterial infection is one of the most common causes of neonatal morbidity and mortality. Early diagnosis and treatment are vital to improve outcome. In the absence of reliable infection markers during the first hours of life, paediatricians often start early antibiotic treatment in newborn infants with risk factors for infection, exposing a considerable number of patients to unnecessary treatment. Procalcitonin (PCT) has been implicated as a sensitive and specific marker of bacterial infection. 2However, it is well established that PCT concentrations in the neonate show a physiological increase during the first two days of life, which complicates the interpretation of results during this period. 3 The aim of this study was to evaluate the diagnostic value of PCT measured in umbilical cord blood before this physiological increase as an early and specific marker of neonatal bacterial sepsis. STUDY DESIGN PatientsWe conducted a prospective study from November 2003 to April 2004 in all children born with a suspected maternofetal infection. Three groups were defined according to clinical, biological, and bacterial criteria: infected, colonised, and noninfected non-colonised. Infected neonates had clinical and postnatal biological signs of sepsis, and a positive central (blood or cerebrospinal fluid) or peripheral bacteriological sample. Colonised neonates had a positive gastric sample, without any clinical or biological sign of sepsis. Non-infected non-colonised neonates had no sign of infection and a negative gastric sample. We also studied a group of newborns without any risk factors, which constituted a control group. MeasurementsWe measured PCT concentration in umbilical cord blood samples using an immuno-chromatographic semiquantitative test (PCT-Q; Brahms, Hennigsdorf, Germany) and C reactive protein (CRP) concentration using an immunoreactive quantitative method. We also measured PCT in maternal blood to evaluate its relevance in the diagnosis of chorioamnionitis. Judgment criteriaThe first judgment criterion was the sensitivity, specificity, and positive and negative predictive values, and positive and negative likelihood ratios of PCT, as assessed by a comparison of PCT concentrations in infected neonates with those in the groups of colonised and non-infected non-colonised neonates. The second criterion involved a comparison of PCT and CRP as predictive markers of neonatal infection. RESULTSA total of 197 newborn infants (167 with suspected maternofetal infection and 30 in the control group) were included in the study; 161 were full term and 36...

Clássicos e novos biomarcadores de sepse neonatal

“…O uso da PCT, da PCR e da leucometria revelou que a contagem de leucócitos na admissão do recém-nascido não tem valor na diferenciação do tipo de infecção nas crianças criticamente doentes e que a PCT teria maior sensibilidade e especificidade nesse período.22 Os valores de PCT e PCR foram avaliados no cordão umbilical de 197 recém-nascidos, sendo detectadas altas taxas de sensibilidade e especificidade para PCT. 23 Os parâmetros microbiológicos, hematológicos e o marcador SE-Selectina foram investigados como preditores precoces para avaliar o desfecho da sepse neonatal, em uma amostragem com 90 casos (sendo 58 infectados e 32 não infectados) e 30 controles.24 SE-Selectina analisada isoladamente demonstrou sensibilidade de 59%, especificidade de 87%, valor preditivo positivo de 81% e valor preditivo negativo de 69%. Além de seu valor diagnóstico, principalmente em associação com a PCR, esse marcador pode ser usado como um indicador de prognóstico de septicemia neonatal e pode prever a etiologia a ser apontada na hemocultura (análise combinada).…”

Procalcitonin – A Reliable Marker for Diagnosis of Neonatal Sepsis in Compare to CRP

“…5 Definitive diagnosis of neonatal sepsis is based on blood culture which take at least 48-72 hours and yields a positive result in only 10-60% of cases. 6 It is also possible that a pseudonegative result may be obtained in some cases. 7 In addition to the blood culture, other tests that are usually used for the diagnosis of neonatal sepsis include estimations of the white blood cell count, the absolute neutrophil count (ANC), micro ESR and I/T ratio.…”

Normal Ranges for Acute Phase Reactants (Interleukin-6, Tumour Necrosis Factor Alpha and C-Reactive Protein) in Umbilical Cord Blood of Healthy Term Neonates at the Mount Hope Women’s Hospital Trinidad

“…Interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), C-reactive protein (CRP) and several other cytokines have been investigated for their role in the inflammatory process and in the prediction of early onset neonatal sepsis (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Interleukin-6 and TNF-α have been identified as being responsible for the induction of the acute phase response and production of cytokines and CRP from hepatocytes (3).…”