Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission.
BACKGROUND
The results of recent studies suggest the usefulness of PCT for early diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to determine the behavior of serum PCT concentrations in both uninfected and infected neonates, and to assess the value of this marker for diagnosis of neonatal sepsis of vertical transmission.


METHODS
PCT was measured in 827 blood samples collected prospectively from 317 neonates admitted to 13 acute-care teaching hospitals in Spain over one year. Serum PCT concentrations were determined by a specific immunoluminometric assay. The diagnostic efficacy of PCT at birth and within 12-24 h and 36-48 h of life was evaluated calculating the sensitivity, specificity, and likelihood ratio of positive and negative results.


RESULTS
169 asymptomatic newborns and 148 symptomatic newborns (confirmed vertical sepsis: 31, vertical clinical sepsis: 38, non-infectious diseases: 79) were studied. In asymptomatic neonates, PCT values at 12-24 h were significantly higher than at birth and at 36-48 h of life. Resuscitation at birth and chorioamnionitis were independently associated to PCT values. Neonates with confirmed vertical sepsis showed significantly higher PCT values than those with clinical sepsis. PCT thresholds for the diagnosis of sepsis were 0.55 ng/mL at birth (sensitivity 75.4%, specificity 72.3%); 4.7 ng/mL within 12-24 h of life (sensitivity 73.8%, specificity 80.8%); and 1.7 ng/mL within 36-48 h of life (sensitivity 77.6%, specificity 79.2%).


CONCLUSIONS
Serum PCT was moderately useful for the detection of sepsis of vertical transmission, and its reliability as a maker of bacterial infection requires specific cutoff values for each evaluation point over the first 48 h of life.
López Sastre
José B
JB
Service of Neonatology, Hospital Universitario Central de Asturias, Oviedo, Spain. jose_lopez_sastre@hotmail.com
Solís
David Pérez
DP
Serradilla
Vicente Roqués
VR
Colomer
Belén Fernández
BF
Cotallo
Gil D Coto
GD
D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006023:Glycoproteins; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000635:transmission
D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide