Inflammatory markers in cord blood or maternal serum for early detection of neonatal sepsis-a systemic review and meta-analysis.
OBJECTIVE
To perform a quantitative review of the evidence on the diagnostic value of inflammatory markers in maternal serum or umbilical cord blood for the diagnosis of early-onset neonatal sepsis (EONS).


METHODS
We searched multiple databases for studies published through March 2013 that evaluated the diagnostic performance of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and leukocyte count (white blood cell, WBC) in either umbilical cord blood or maternal serum for diagnosis of EONS. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models.


RESULTS
Our search identified 3874 citations, of which 15 studies evaluating 2178 episodes of suspected neonatal infection were included for analysis. IL-6 in cord blood with a pooled-positive likelihood ratio (LR+) of 9.47 (95% confidence interval: 3.86 to 23.3), PCT in cord blood with a LR+ of 5.72 (1.56 to 21.0) and IL-6 in maternal serum with a LR+ of 5.47 (2.10 to 14.2) can be qualified as a valid rule-in test. IL-6 in cord blood with a LR- of 0.10 (0.05 to 0.21) and PCT in cord blood with a LR- of 0.20 (0.12-0.37) can be qualified as a useful rule-out test. Either CRP or WBC was inadequate for diagnosis of EONS.


CONCLUSIONS
For cord blood sample, IL-6 or PCT can be used as reliable rule-in and rule-out tool. For maternal serum, only IL-6 appeared to be sufficient for rule-in diagnosis. An interventional study may be needed to answer whether the addition of these tests will improve the outcome of patients with EONS.
Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
H
H
Su
1] Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, and Chang Gung University College of Medicine, Taoyuan, Taiwan [2] Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
S-S
SS
Chang
Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
C-M
CM
Han
Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
K-Y
KY
Wu
Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
M-C
MC
Li
Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
C-Y
CY
Huang
Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
C-L
CL
Lee
1] Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, and Chang Gung University College of Medicine, Taoyuan, Taiwan [2] Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J-Y
JY
Wu
1] Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan [2] Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan.
C-C
CC
Lee
D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D042241:Early Diagnosis; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D007231:Infant, Newborn; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology
C000606589:CALCA protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide