[Diagnostic value of granulocyte elastase determination in cord blood of newborn infants at risk for maternofetal infection].
BACKGROUND
Polymorphonuclear elastase is an early and sensitive indicator of neonatal infection when performed at the beginning of clinical symptoms.


METHODS
To investigate the diagnostic value of elastase measurement in cord blood immediately after birth, 211 neonates (103 boys vs 108 girls, 154 vaginal delivery vs 57 cesarean section). Mean gestational age 38.9 weeks (range: 30-42), mean birth weight 3,260 g (range: 1,430-4,920 g). After clinical, bacterial and biological screening, the infants were classified in three groups. Group A (n = 118): none infectious risk factor neither clinical signs of infection; group B (n = 79): one or more risk factors but no evidence of infection; group C (n = 14): proved or probable infection. Polymorphonuclear elastase was measured in cord blood of all infants using an heterogeneous enzyme-linked-immunosorbent assay.


RESULTS
We observed higher elastase values in group C (176 +/- 67 micrograms/L) than in group A (91 +/- 64 micrograms/L) and B (67 +/- 61 micrograms/L) (mean +/- SD, P = 0.0001). With a cutoff value fixed at 80 micrograms/L, the sensitivity of this test applicated to neonates presenting materno-fetal infectious risk factor(s) was 85% (12/14), specificity 74% (59/79), positive predictive value 37%, and negative predictive value 96%.


CONCLUSIONS
Because two of the 14 infected infants (15%) were not detected by elastase dosage in cord blood, this test cannot be used as an early indicator of materno-fetal infection.
Sampériz
S
S
Service de néonatologie, hôpital d'enfants de la Timone, Marseille, France.
Millet
V
V
Lacroze
V
V
Unal
D
D
D005260:Female; D005312:Fetal Blood / Q000201:enzymology*; D006098:Granulocytes / Q000201:enzymology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000201:enzymology*; D019272:Leukocyte Elastase / Q000097:blood*; D008297:Male; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000201:enzymology*; D012307:Risk Factors
D019272:Leukocyte Elastase
Valeur diagnostique du dosage de l'élastase granulocytaire au sang du cordon ombilical chez des nouveau-nés en situation de risque d'infection maternofoetale.