title: Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia.
abstract: BACKGROUND
  Vasopressin is one of the most important physiological stress and shock hormones. Copeptin, a stable vasopressin precursor, is a promising sepsis marker in adults. In contrast, its involvement in neonatal diseases remains unknown. The aim of this study was to establish copeptin concentrations in neonates of different stress states such as sepsis, chorioamnionitis and asphyxia.
  
  
  METHODS
  Copeptin cord blood concentration was determined using the BRAHMS kryptor assay. Neonates with early-onset sepsis (EOS, n = 30), chorioamnionitis (n = 33) and asphyxia (n = 25) were compared to a control group of preterm and term (n = 155) neonates.
  
  
  RESULTS
  Median copeptin concentration in cord blood was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin cord blood concentrations were non-normally distributed and increased with gestational age (p < 0.0001). Neonates born after vaginal compared to cesarean delivery had elevated copeptin levels (p < 0.0001). Copeptin correlated strongly with umbilical artery pH (Spearman's Rho -0.50, p < 0.0001), umbilical artery base excess (Rho -0.67, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001). No difference was found when comparing copeptin cord blood concentrations between neonates with EOS and controls (multivariate p = 0.30). The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l). Receiver-operating-characteristic curve analysis showed that copeptin cord blood concentrations were strongly associated with asphyxia: the area under the curve resulted at 0.91 (95%-CI 0.87-0.96, p < 0.0001). A cut-off of 400 pmol/l had a sensitivity of 92% and a specifity of 82% for asphyxia as defined in this study.
  
  
  CONCLUSIONS
  Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery. In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.
authors: Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Bern, Switzerland. luregn.schlapbach@gmail.com
authors: Luregn J
authors: LJ
authors: Schlapbach
authors: Stefanie
authors: S
authors: Frey
authors: Susanna
authors: S
authors: Bigler
authors: Chiem
authors: C
authors: Manh-Nhi
authors: Christoph
authors: C
authors: Aebi
authors: Mathias
authors: M
authors: Nelle
authors: Jean-Marc
authors: JM
authors: Nuoffer
references: Acta Paediatr. 2008 Apr;97(4):500-2
references: 18307552
references: N Engl J Med. 2009 Oct 1;361(14):1349-58
references: 19797281
references: Crit Care. 2006;10(3):R71
references: 16677425
references: N Engl J Med. 2002 Jul 25;347(4):240-7
references: 12140299
references: Neonatology. 2010;97(1):22-8
references: 19571584
references: Peptides. 2005 Dec;26(12):2500-4
references: 15922490
references: J Am Coll Cardiol. 2009 Jun 30;54(1):60-8
references: 19555842
references: Shock. 2007 Dec;28(6):644-649
references: 18092379
references: J Clin Endocrinol Metab. 2010 Nov;95(11):5091-6
references: 20702521
references: J Matern Fetal Neonatal Med. 2009;22 Suppl 3:57-61
references: 19718579
references: Intensive Care Med. 2009 Mar;35(3):489-97
references: 18825368
references: Eur J Clin Invest. 2007 Feb;37(2):145-52
references: 17217381
references: Shock. 2007 Aug;28(2):219-26
references: 17515850
references: Lancet. 2005 Mar 5-11;365(9462):891-900
references: 15752534
references: Pediatr Res. 2006 Mar;59(3):478-83
references: 16492993
references: Anesthesiology. 2006 Sep;105(3):599-612; quiz 639-40
references: 16931995
references: Pediatr Crit Care Med. 2004 Mar;5(2):116-8
references: 14987339
references: Am J Respir Crit Care Med. 2009 Oct 1;180(7):632-9
references: 19608718
references: Pediatr Crit Care Med. 2008 Jul;9(4):372-9
references: 18496412
references: Stress. 2009 Jul;12(4):294-304
references: 18951250
references: Pediatrics. 2009 Jul;124(1):350-7
references: 19564319
references: BJOG. 2006 Apr;113(4):441-5
references: 16489937
references: Lancet Infect Dis. 2004 Oct;4(10):620-30
references: 15451490
references: N Engl J Med. 2008 Feb 28;358(9):877-87
references: 18305265
references: Arch Neurol. 1976 Oct;33(10):696-705
references: 987769
references: Clin Chem. 2006 Jan;52(1):112-9
references: 16269513
references: Crit Care Med. 2009 Feb;37(2):749-50
references: 19325368
references: J Pediatr. 2010 Sep;157(3):502-4
references: 20727442
references: J Child Neurol. 2002 Nov;17(11):824-9
references: 12585722