Chaouachi S, Marrakchi O, Ben Hamida E, Abidi K, Béchir Z, Abdelmoula Jouda J, Marrakchi Z
Service de néonatologie, hôpital Charles-Nicolle, boulevard 9avril1938CP, 1009 Tunis, Tunisie.
Arch Pediatr. 2011 Mar;18(3):267-71. doi: 10.1016/j.arcped.2010.12.009. Epub 2011 Jan 26.
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.
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.
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).
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%.
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.
早期诊断并避免对母婴细菌感染进行不必要的治疗，仍然是产科医生和儿科医生面临的最大挑战之一。为实现这些目标，人们使用了许多炎症介质，包括降钙素原（PCT）。我们研究的目的是确定PCT在新生儿感染早期诊断和管理中的作用。
在8个月的时间里，所有根据我们新生儿病房方案拟接受抗生素治疗的高度疑似母婴细菌感染的存活新生儿被纳入这项前瞻性研究。使用特定的免疫发光分析法在出生时和出生后12小时测定血清PCT浓度。根据临床、生物学和细菌学标准定义了两个不同的群体：第1组：感染新生儿，第2组：未感染新生儿。
我们比较了不同组的PCT均值，并通过分析受试者工作特征曲线（ROC）确定与母婴细菌感染相关的临界值。
共有130名新生儿纳入研究：38名（29%）被归类为第1组，其中29例可能感染，9例确诊感染，包括5例败血症。第1组出生时的平均PCT显著高于第2组（3.52±8.19 ng/ml对0.43±0.73 ng/ml；P<0.001）。ROC曲线得出的出生时PCT临界值，其最高灵敏度（71.1%）和最高特异性（62%）为0.215 ng/ml。阴性预测值（NPV）为83.8%，这使得在大多数情况下能够避免不必要的治疗。出生后12小时内的PCT临界值为3.78 ng/ml，灵敏度为89.5%，NPV为94.4%。
PCT是一项有价值的生物学检查，因为它可以早期进行检测，具有敏感性，且有阴性预测值。这些特性使PCT成为可用于抗生素给药初始决策的生物学依据。还将进行另一项研究以确定临界值。
