title: [Usefulness of serum procalcitonin in the early diagnosis of maternal-fetal bacterial infection. A prospective study].
abstract: Early diagnosis avoiding unnecessary treatment of maternal-fetal bacterial infection remains one of the greatest challenges for obstetricians and pediatricians. To meet these objectives, many inflammatory mediators were used, including procalcitonin (PCT). The aim of our study was to determine the usefulness of PCT in early diagnosis and management of neonatal infection.
  
  
  METHODS
  Over a period of 8 months, all living newborns with highly suspected maternal-fetal bacterial infection who were to receive antibiotic treatment according to our neonatal unit protocol were included in this prospective study. Serum PCT concentrations were determined at birth and after 12h of life using a specific immunoluminometric assay. Two distinct populations were defined based on clinical, biological, and bacteriological criteria: group 1: infected neonates, and group 2: noninfected neonates.
  
  
  METHODS
  We compared PCT means in different groups and determined the cut-off value correlated with maternal-fetal bacterial infection by analyzing the receiver operating characteristics curve (ROC).
  
  
  RESULTS
  A total of 130 neonates were included in the study: 38 (29%) were classified in group 1 with 29 possible infections and 9 defined infections, including 5 cases of septicemia. The average PCT at birth in group 1 was significantly higher than in group 2 (3.52 ± 8.19 ng/ml vs 0.43 ± 0.73 ng/ml; P<0.001). The PCT threshold value at birth found by the ROC curve with the highest sensitivity (71.1%) and highest specificity (62%) was 0.215 ng/ml. The negative predictive value (NPV) was 83.8%, making it possible to avoid unnecessary treatment in the majority of the cases. The PCT threshold value within 12h of birth was 3.78 ng/ml, for a sensitivity of 89.5% and 1 NPV of 94.4%.
  
  
  CONCLUSIONS
  PCT is a valuable biological examination because it can be administered early, it is sensitive, and it has a NPV. These characteristics make PCT a biological argument that can be used in the initial decision on whether to administer antibiotics. Another study will be conducted to establish the cut-off value.
authors.affiliation: Service de néonatologie, hôpital Charles-Nicolle, boulevard 9avril1938CP, 1009 Tunis, Tunisie. chaouachisihem@yahoo.fr
authors.forename: S
authors.initials: S
authors.lastname: Chaouachi
authors.forename: O
authors.initials: O
authors.lastname: Marrakchi
authors.forename: E
authors.initials: E
authors.lastname: Ben Hamida
authors.forename: K
authors.initials: K
authors.lastname: Abidi
authors.forename: Z
authors.initials: Z
authors.lastname: Béchir
authors.forename: J
authors.initials: J
authors.lastname: Abdelmoula Jouda
authors.forename: Z
authors.initials: Z
authors.lastname: Marrakchi
mesh_terms: D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide