title: Elastase alpha 1 proteinase inhibitor complex, granulocyte count, ratio of immature to total granulocyte count, and C-reactive protein in neonatal septicaemia.
abstract: In a prospective study elastase alpha 1-proteinase inhibitor (E alpha 1PI), polymorphonuclear (PMN) count, the immature to total neutrophil count ratio (I/T ratio), and C-reactive protein (CRP) were analysed in 74 patients (76 cases) with neonatal septicaemia at the time of initial clinical symptoms. At that early stage of the disease, 94% of the patients had abnormal values for E alpha 1PI, 71% for I/T ratio, 61% for PMN count, and only 54% for CRP. PMN count was a poor indicator of septicaemia. Neutropenia, present in 26% of all patients, was related to normal E alpha 1PI in only 4 patients. The combined use of E alpha 1 and I/T ratio was the most sensitive indicator. In all patients irrespective of causative bacteria or disease onset at least one of these parameters was elevated. In early-onset septicaemia (n = 31), normal CRP values occurred significantly more often (63%) than in late-onset sepsis (33%). Even in five of the seven fatal cases, initial CRP measurements were normal. The sensitivity of PMN count and I/T ratio did not differ significantly between early- and late-onset septicaemia. Laboratory changes observed in 18 newborns during the first 3 days of the septic episode show that the rate of pathological values for E alpha 1PI and I/T ratio was highest at the time of initial clinical symptoms and decreased on days 2 and 3. In contrast, CRP reached maximal values as late as day 2 (88% abnormal values), followed by a decrease on day 3. We conclude that the use of E alpha 1PI may improve the laboratory detection of neonatal septicaemia especially if used in combination with I/T ratio.
authors.affiliation: Department of Paediatrics, Medical University of Leubeck, Federal Republic of Germany.
authors.forename: F K
authors.initials: FK
authors.lastname: Tegtmeyer
authors.forename: C
authors.initials: C
authors.lastname: Horn
authors.forename: A
authors.initials: A
authors.lastname: Richter
authors.forename: J
authors.initials: J
authors.lastname: van Wees
mesh_terms: D016470:Bacteremia / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000378:metabolism*; D005500:Follow-Up Studies; D006098:Granulocytes; D006801:Humans; D007231:Infant, Newborn; D007958:Leukocyte Count; D009504:Neutrophils; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
chemical_list: D000515:alpha 1-Antitrypsin; D002097:C-Reactive Protein