Department of Neonatology, Meram Medical Faculty, Selçuk University, 42080 Konya, Turkey.
Int J Infect Dis. 2011 Dec;15(12):e854-8. doi: 10.1016/j.ijid.2011.09.007. Epub 2011 Oct 22.
The clinical signs of early-onset neonatal sepsis (EONS) are nonspecific and indistinguishable from those of noninfectious disorders. The early diagnosis of EONS is difficult, but is essential to improve outcomes. The aim of this study was to determine the diagnostic value of procalcitonin (PCT) at birth and at 24h of age in the prompt diagnosis of EONS.
The patient group consisted of neonates with a Töllner score of ≥ 10 or a Töllner score of 5-10 but with the presence of prolonged rupture of the membranes (> 18 h) or chorioamnionitis or maternal fever (n=171). The control group (n=89) comprised neonates admitted to the neonatal intensive care unit for different disease entities. Procalcitonin levels at birth (first) and at 24h of age (second) were measured for each neonate in both of the study groups.
There was no difference between the two groups in terms of gender, birth weight, or gestational age. The mean (min-max) first PCT level was 0.48 (0.07-3.48)ng/ml in the controls and 0.51 (0.09-28.6)ng/ml in patients. The mean (min-max) second PCT level was 1.72 (0.21-18.23)ng/ml in the controls and 16.17 (0.17-100)ng/ml in patients. There was no statistically significant difference in PCT levels between the patient and control groups at birth. However, at 24h of age, PCT levels were significantly higher in the patient group than in the control group (p<0.001). Serum PCT levels in controls at 24h of age were slightly increased compared to levels at birth, but as a normal reaction. PCT thresholds for the diagnosis of sepsis were 0.59 ng/ml at birth (sensitivity 48.7%, specificity 68.6%) and 5.38 ng/ml at 24h of life (sensitivity 83.3%, specificity 88.6%).
In EONS, PCT measurements at birth may initially be normal; a serial PCT measurement at 24h of age may be more helpful for an early diagnosis. During the first 24h of life PCT is a more sensitive marker of infection than C-reactive protein. Further studies are needed to confirm our findings.
早发型新生儿败血症（EOS）的临床体征是非特异性的，与非传染性疾病无法区分。EOS 的早期诊断较为困难，但对于改善预后至关重要。本研究旨在确定降钙素原（PCT）在出生时和 24 小时时对 EOS 快速诊断的诊断价值。
患者组由 Tollner 评分≥10 分或 Tollner 评分为 5-10 分但伴有延长的胎膜破裂（>18 小时）或绒毛膜羊膜炎或母亲发热的新生儿组成（n=171）。对照组（n=89）包括因不同疾病实体而入住新生儿重症监护病房的新生儿。对两组中每个新生儿出生时（第一次）和 24 小时时（第二次）的降钙素原水平进行测量。
两组之间在性别、出生体重或胎龄方面没有差异。对照组的平均（最小-最大）第一次 PCT 水平为 0.48（0.07-3.48）ng/ml，患者组为 0.51（0.09-28.6）ng/ml。对照组的平均（最小-最大）第二次 PCT 水平为 1.72（0.21-18.23）ng/ml，患者组为 16.17（0.17-100）ng/ml。两组新生儿出生时的 PCT 水平无统计学差异。然而，在 24 小时时，患者组的 PCT 水平明显高于对照组（p<0.001）。对照组 24 小时时的血清 PCT 水平与出生时相比略有升高，但作为正常反应。出生时和 24 小时时诊断败血症的 PCT 阈值分别为 0.59ng/ml（敏感性 48.7%，特异性 68.6%）和 5.38ng/ml（敏感性 83.3%，特异性 88.6%）。
在 EOS 中，出生时的 PCT 测量值最初可能正常；在 24 小时时进行连续 PCT 测量可能对早期诊断更有帮助。在生命的前 24 小时内，PCT 是比 C 反应蛋白更敏感的感染标志物。需要进一步的研究来证实我们的发现。
