Vasilcan Genoveva, Avasiloaiei Andreea, Moscalu Mihaela, Dimitriu A G, Stamatin Maria
Universităţii de Medicină şi Farmacie "Gr. T. Popa" Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1243-50.
Neonatal infection represents the third most important cause of mortality in Neonatal Intensive Care Units (NICU), following perinatal asphyxia and respiratory distress syndrome. The incidence varies according to the level of care, between 5% in level II neonatal wards and 20% in the NICUs. The lack of specific early markers for infection could be partially responsible for the lack of antibiotic treatment or unnecessary treatment. In this context, many variables were examined as markers for sepsis. Large concentrations of C-reactive proteine (CRP) and procalcitonine (PCT) were positively correlated with the severity of the infection and generally indicated a poor outcome.
The aim of this study is to demonstrate the utility of PCT as a fast, early and routinely used marker of neonatal infection, correlated with CRP, clinical symptoms and blood cultures.
this is a retrospective-prospective study on 2 lots of newborns from two neonatal wards of different levels of care (Lot I - 32 newborns from the Cuza-Voda NICU in Iasi, born in 2010, Lot II - 127 newborns from the Buna Vestire Maternity in Galati, born during 2008-2009). PCT was assessed before the beginning of the antibiotic treatment in newborns with high risk of sepsis or newborns with proven sepsis as corroborated with complete blood counts, CRP, fibrinogen, clinical symptoms and blood cultures.
Among risk factors for neonatal infection, those found more often in newborns with proven sepsis are: ruptured membranes over 18 hours (p=0.043), Gram-negative bacilli colonization (p=0.003), respiratory distress syndrome (p=0.0008), abdominal distention (p=0.0042), oedema (p<<0.05) and necrotizing enterocolitis (p<<0.05). High values for PCT in premature newborns show the high risk for infection for this category of newborns, due to immunological imaturity and the presence of risk factors. High sensitivity and specificity of PCT (specificity =88.98%, sensitivity=87.5%) showed that the accuracy of PCT assessment in studied lots was 88.68% during the 24-72 hours of life time frame.
High serum levels of PCT in studied lots plead for the usage of PCT for the fast and early diagnostis of neonatal infection. In those cases with positive PCT and negative blood cultures or positive CRP and clinical symptoms of infection, PCT would be a useful tool, aiding in the initiation or termination of antibiotic treatment, which would ultimately lead to lowering costs. PCT as a screening tool for cases with risk factors for infection is still to be analysed in terms of costs versus benefits and the longterm implications of neonatal sepsis and antibiotic treatment.
新生儿感染是新生儿重症监护病房（NICU）中第三大重要死亡原因，仅次于围产期窒息和呼吸窘迫综合征。其发病率因护理水平而异，在二级新生儿病房中为5%，在NICU中为20%。缺乏感染的特异性早期标志物可能是导致抗生素治疗不足或不必要治疗的部分原因。在此背景下，许多变量被作为脓毒症的标志物进行研究。高浓度的C反应蛋白（CRP）和降钙素原（PCT）与感染的严重程度呈正相关，通常提示预后不良。
本研究的目的是证明PCT作为一种快速、早期且常规使用的新生儿感染标志物的实用性，并与CRP、临床症状和血培养结果相关联。
这是一项对来自两个不同护理水平新生儿病房的两组新生儿进行的回顾性-前瞻性研究（第一组-2010年在雅西的库扎-沃达NICU出生的32名新生儿，第二组-2008 - 2009年在加拉茨的布纳·韦斯蒂尔妇产医院出生的127名新生儿）。在患有脓毒症高风险或已确诊脓毒症的新生儿中，在开始抗生素治疗前，结合全血细胞计数、CRP、纤维蛋白原、临床症状和血培养结果对PCT进行评估。
在新生儿感染的风险因素中，在已确诊脓毒症的新生儿中更常出现的因素有：胎膜破裂超过18小时（p = 0.043）、革兰氏阴性杆菌定植（p = 0.003）、呼吸窘迫综合征（p = 0.0008）、腹胀（p = 0.0042）、水肿（p << 0.05）和坏死性小肠结肠炎（p << 0.05）。早产儿中PCT值高表明这类新生儿因免疫不成熟和存在风险因素而感染风险高。PCT的高敏感性和特异性（特异性 = 88.98%，敏感性 = 87.5%）表明，在出生后24 - 72小时的时间范围内，研究组中PCT评估的准确性为88.68%。
研究组中高血清水平的PCT支持将PCT用于新生儿感染的快速早期诊断。在PCT阳性而血培养阴性或CRP阳性且有感染临床症状的情况下，PCT将是一个有用的工具，有助于启动或终止抗生素治疗，最终降低成本。PCT作为感染风险因素病例的筛查工具，在成本效益以及新生儿脓毒症和抗生素治疗的长期影响方面仍有待分析。
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