title: Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study.
abstract: OBJECTIVE
  To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS.
  
  
  METHODS
  This is a prospective study of newborns admitted to the neonatal intensive care unit after CS.
  
  
  METHODS
  PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery.
  
  
  RESULTS
  A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours,P= 0.564; 48 hours,P= 0.117; 72 hours,P= 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P= 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709-0.958),P< 0.0001, and sensitivity and specificity of 87.5% (29.6-99.7) and 72.6% (53.5-86.4), respectively.
  
  
  CONCLUSIONS
  This is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients.
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
authors.forename: Sara Bobillo
authors.initials: SB
authors.lastname: Pérez
authors.affiliation: Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Rodríguez-Fanjul
authors.affiliation: Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Paediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain.
authors.forename: Iolanda Jordan
authors.initials: IJ
authors.lastname: García
authors.affiliation: Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain.
authors.forename: Julio Moreno
authors.initials: JM
authors.lastname: Hernando
authors.affiliation: Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain.
authors.forename: Martín
authors.initials: M
authors.lastname: Iriondo Sanz
keywords: C-reactive protein; inflammatory syndrome; newborn; postcardiopulmonary bypass; procalcitonin; sepsis