calca-protein--human and Infant--Newborn--Diseases

A meta-analysis was performed to assess the accuracy of the procalcitonin (PCT) test for diagnosing neonatal sepsis. The major databases, MEDLINE, EMBASE and the Cochrane Library were searched for studies published between January 1996 and May 2009 that evaluated PCT as a diagnostic marker for neonatal sepsis and provided sufficient data to calculate sensitivity and specificity. Twenty-two studies were included in the analysis. Trials that evaluated the PCT test for the diagnosis of early-onset neonatal sepsis at different time points (birth, 0-12 h, 12-24 h, and 24-48 h) and late-onset neonatal sepsis (LONS) all showed moderate accuracy (Q* = 0.79, 0.86, 0.81, 0.82, and 0.77, respectively). The PCT test was more accurate than the C-reactive protein (CRP) test for the diagnosis of LONS. A sensitivity analysis found that differences in PCT assay producer, gestational age and severity of sepsis in the study population may partially explain the between-studies heterogeneity. The PCT test showed moderate accuracy in diagnosing neonatal sepsis, regardless of differences in diagnostic criteria and time points for testing. For the diagnosis of LONS, the PCT test showed better accuracy than the CRP test. PCT is a valuable additional tool for the diagnosis of neonatal sepsis.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Clinical Trials as Topic; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Protein Precursors; Sensitivity and Specificity; Sepsis; Severity of Illness Index

Infections are highly prevalent in the neonatal period. Unfortunately the symptoms of infection are non-specific and are seen in other neonatal diseases as: respiratory distress syndrome, metabolic diseases, intracranial hemorrhages. Diagnosis is based on the clinics, microbiologic tests and laboratory markers of infection. Considering the high mortality and serious morbidity associated with neonatal sepsis, a diagnostic marker with a very high sensitivity and negative predictive value approaching 100% is desirable. Unfortunately there is no laboratory marker that has all of the characteristics of ideal infection marker. Procalcitonin, interleukins 6 and 8, CD 11b are early, sensitive markers of infection. C- reactive protein is a late specific marker of infection. CD 64 is the most sensitive marker of late, nosocomial infection. Serial measurement of infection markers will certainly improve the diagnostic sensitivity of these tests, because in most circumstances it is not certain at which stage of the infection the specimen should be taken for analysis. In addition, the use of multiple markers, in particular, combining an early sensitive marker with a late specific test will further enhance the diagnostic accuracy of these mediators in identifying infected cases.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Communicable Diseases; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Interleukins; Protein Precursors; Sepsis

Neonatal sepsis occurs from 1 to 21 newborns out of 1 000 live births with mortality rates as high as 30% up to 69%. The most important risk factors are prematurity, low birth weight, invasive medical procedure and prolonged hospitalization in neonatal intensive care units. An aimed and restrictive antibiotic therapy has an outstanding importance to reduce both morbidity-mortality rates and multiple drug-resistance. Generally, preterm newborns present nonspecific clinical signs of infection. The use of high sensitivity infection markers and a negative predictive value (near 100%) are important to distinguish infected and noninfected patients before the culture results and to verify adequacy and duration of antibiotic therapy. This article reviews the immunologic function and practical use of C reactive protein (CRP) and other markers in the diagnosis of neonatal sepsis. While CRP is a specific late infection marker, cytokines, cell surface markers and procalcitonin (PCT) are early infection markers. The use of multiple markers as CRP, PCT, IL-6, IL-8, CD64, CD11b is useful both to early (24-48 h) diagnose of neonatal sepsis, and to monitorate the antibiotic treatment while waiting for the results of cultural examinations.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Predictive Value of Tests; Protein Precursors; Risk Factors; Sensitivity and Specificity; Sepsis

Early diagnosis and treatment of the newborn infant with suspected sepsis are essential to prevent severe and life threatening complications. Diagnosis of neonatal sepsis is difficult because of the variable and nonspecific clinical presentation. Therefore, many newborns with nonspecific symptoms are started on antibiotic treatment before the presence of sepsis has been proven. With our recently published single-centre intervention study we were able to show that Procalcitonin determinations allowed to shorten the duration of antibiotic therapy in newborns with suspected early-onset sepsis.. The study is designed as randomized controlled international multicenter intervention trial on the efficacy and safety of Procalcitonin guided treatment. Term and near-term infants (gestational age ≥ 34 0/7 weeks) with suspected sepsis in the first 3 days of life requiring empiric antibiotic therapy will be included. The duration of antibiotic therapy in the standard group is based on the attending physician's assessment of the likelihood of infection (infection unlikely, possible, probable or proven). In the Procalcitonin group, if infection is considered to be unlikely or possible, antibiotic therapy is discontinued when two consecutive Procalcitonin values are within the normal range. Co-primary outcome measures are the duration of antibiotic therapy (superiority aspect of the trial) and the proportion of infants with a recurrence of infection requiring additional courses of antibiotic therapy and/or death in the first month of life (safety of study intervention, non-inferiority aspect of the trial). The number of infants to be included equals 800 per arm. With these numbers the power of the study to demonstrate superiority for duration of antibiotic therapy as well as non-inferiority regarding safety, i.e. excluding a disadvantage difference larger than 2% for the experimental arm, will both be greater than 80%.. Benefit of the study is a possible limitation of unnecessary use of antibiotics. The results of our first study suggest that there is a low risk on discontinuing antibiotic treatment too early, resulting in the development of a neonatal infection with its morbidity and mortality.. This trial is registered in the U.S. National Institutes of Health's register, located at http://www.clinicaltrials.gov. (NCT00854932).

Topics: Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Drug Administration Schedule; Early Diagnosis; Female; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; International Cooperation; Male; Protein Precursors; Secondary Prevention; Sepsis; Treatment Outcome

To study the clinical practice of procalcitonin and hypersensitive c-reactive protein test in neonatal infection. Two hundred cases of our hospital treatment confirmed infection early newborn children were selected from February 2014 to March 2015. According to the condition, the children were divided into four groups as follows: severe infection group, local infection group, non-infection group and healthy newborns group. At the same time, the new healthy newborns were chosen as control group. The levels of serum procalcitonin and high-sensitivity C-reactive protein were detected in all children and the levels in severe infection group children before and after treatment were also quantitatively detected and the test results were analyzed. There was significant difference in procalcitonin among the four groups (pS<0.05). The positive rate of the high-sensitivity C-reactive protein in local infection group has no significant difference compared with the non-infection group (p>0.05). But there was significant difference between the local infection group and healthy newborn group. As for the severe infection group, both the levels of procalcitonin and positive rate of high-sensitivity C-reactive protein had significant difference compared with the other groups. The detection of procalcitonin and high-sensitivity C-reactive protein could contribute to the diagnose of the early infection neonatal children and has important values in diagnosis and treatment of infectious diseases in the newborns.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Protein Precursors

Procalcitonin /PCT/ is a reliable marker for the diagnosis of early onset neonatal sepsis but its sensitivity and specificity in literature vary widely mostly due to existing unclarity on its normal values and kinetics in the postnatal period. Aim of our research is to study the normal values of PCT and its dynamics during the first 24 hours of life for the Bulgarian population.. 70 healthy neonates were prospectively enrolled and separated in the following 3 groups (Group 1- immediately afterbirth; Group 2- 0-12 h afterbirth; Group 3- 12-24 h afterbirth) regarding the age at the time of PCT testing. The selected method of PCT testing is direct chemiluminescence. Results were analyzed with Statistical Package for Social Science (SPSS).. For group 1 and group 2 the mean PCT level was 0.06 and 0.59 ng/ml respectively. In group 3 PCT concentrations reached peak mean values of 3.35ng/ml. In the last group also the greatest variations were observed PCTmin - 0.31 ng/ml, PCTmax - 23.81 ng/ml. No correlation between PCT concentrations, sex, mode of delivery and parity was found.. During the first 24 hours of life PCT values in healthy term neonates show broad variations, most marked in the interval 12-24 h. The dynamics of PCT concentrations is characterized by a gradual increase from birth reaching peak levels approximately 24 hours later.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Luminescent Measurements; Male; Pregnancy; Prospective Studies; Protein Precursors; Sepsis

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.

Topics: Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Protein Precursors; ROC Curve

To assess the impact of prenatal antibiotic treatment on procalcitonin (PCT) and C-reactive protein (CRP) concentrations in cord blood, and on the rate of positive neonatal blood cultures.. Neonates with early-onset infection (Group A; n=46) were compared with healthy controls (Group B; n=240). We evaluated the relationship between prenatal antibiotic therapy and early-onset infection, and for interactions with antibiotic therapy in the neonate immediately after birth.. In the Group A antibiotics were administered significantly more often prenatally and more often to neonates just after birth. The percentage of negative blood cultures in infected neonates was higher when antibiotic treatment was instituted prenatally. Differences in cord blood PCT and CRP concentrations were significant between both groups and were independent of prenatal antibiotic treatment. Streptococcus agalactiae was the most frequent species.. Almost one-third of neonates present with early-onset infection in spite of prenatal antibiotic therapy. Cord blood PCT and CRP measurements may be helpful in the diagnosis of infection also in cases when antibiotic therapy was started prenatally. Prenatal antibiotic administration reduced the number of positive blood cultures in neonates with early-onset infection and was associated with a greater rate of antibiotic treatment after birth in neonates without infection.

Topics: Anti-Bacterial Agents; Bacteremia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Fetal Blood; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Male; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care; Protein Precursors; Streptococcus agalactiae

The aim of this study was to evaluate the predictive value of resistin and visfatin in neonatal sepsis, and to compare these adipocytokines with C-reactive protein (CRP), procalcitonin and interleukin 6 (IL-6).. A total of 62 term or near term infants with sepsis proven by positivity of blood culture, and 43 healthy infants were included in this study.. There were no statistically significant differences between the two groups as regards birthweight and gestational age. White blood cell count (p= 0.039), CRP levels (p=0.01), procalcitonin levels (p=0.01), IL-6 levels (p= 0.01), visfatin levels (p=0.01) and resistin levels (p=0.01) were significantly higher in septic infants. There was a positive correlation between visfatin, resistin and other markers (WBC, CRP, procalcitonin and IL-6). A cut-off value of 10 ng/mL for visfatin, showed 92% sensitivity and 94% specificity, and a cut-off value of 8 ng/mL for resistin showed 93% sensitivity and 95% specificity for neonatal sepsis.. In the light of these results, visfatin and resistin can be used as a diagnostic marker similar to CRP, procalcitonin and IL-6 in neonatal sepsis. Further studies are needed to better understand the role and predictive value of these molecules in neonatal sepsis.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Interleukin-6; Nicotinamide Phosphoribosyltransferase; Pregnancy; Protein Precursors; Resistin; Sepsis

Materno foetal infection (MFI) remains one of the major causes of neonatal morbidity and mortality. Early detection of neonatal sepsis can be difficult, because the first signs of the disease may be unspecific and similar to symptoms of other non-infectious processes.. We aimed to investigate the role of procalcitonin (PCT) in the diagnosis of fetal infection (MFI), and to compare it with those of the C-reactive protein (CRP).. We have conducted a prospective study during 20 months: which concerned 25 newborns suspected of MFI and admitted before 12 hours of life. All newborn had anamnestic and/or physical signs of possible infection. MFI was confirmed in newborns with positive bacterial analysis. CRP and PCT were determined in the sera at H12, H24, H36 and H48. Newborns were divided into: patients with recognized MFI (group 1), patients with possible MFI (group2) and non infected newborns (group 3):. The specificity of PCT was 80% versus 27% for the CRP. Negative predictive value of PCT was 85% versus 66% for the CRP. The mean values, at H12, H24, H36 and H48, of PCT for newborn who had MFI were statistically grater than those for no infused group (p<0.05). No statistical difference was observed concerning CRP values.. PCT may a useful tool in early diagnosing of MFI; it has better specificity and negative predictive value than CRP.

Topics: Bacterial Infections; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Male; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Protein Precursors; Sensitivity and Specificity

The aim of this study was to test the diagnostic model of combining procalcitonin (PCT) and C-reactive protein (CRP) levels in the cord blood and routinely used biochemical parameters and clinical data in the prediction of early onset neonatal infection.. PCT and CRP concentrations were measured in cord blood of neonates with infection (group A, n=46) and compared with uninfected neonates (group B, n=240). Inclusion criteria for group A were based on obstetric history, clinical data and results of laboratory tests. Logistic regression was applied. The receiver operating characteristic (ROC) curves were constructed for PCT, CRP and the diagnostic model.. There was a highly significant (p<0.000001) difference in PCT and CRP concentrations between both groups. The cut-off point for PCT in cord blood was 1.22 ng/mL [sensitivity % (SE%) 80.43, specificity % (SP%) 71.67, positive predictive value % (PPV%) 35.24, negative predictive value % (NPV%) 95.03], and 1.0 mg/L for CRP (SE% 73.91, SP% 77.92, PPV% 39.08, NPV% 93.97). In total, seven variables were included in the model (concentrations of PCT and CRP in cord blood, tocolysis, nutritional status of the newborn, Apgar score, neutrophil ratio and red blood cell count in neonatal venous blood), which proved to offer the highest sensitivity (91.3%; 95% CI: 83-99) and specificity (90%; 95% CI: 86-94) for the detection of early onset neonatal infection. The likelihood ratio for the model was high at 9.13, with PPV% 63.64 (95% CI: 52-75), NPV% 98.18 (95% CI: 96-100) and calculated area under the curve at 0.973.. The diagnostic model based on seven clinical and laboratory parameters, using the concentration of PCT and CRP measurements in the cord blood, could be a useful tool for the prediction of early onset neonatal infection.

Topics: Adult; Age of Onset; Area Under Curve; Bacterial Infections; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Fetal Blood; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Predictive Value of Tests; Pregnancy; Protein Precursors; ROC Curve; Time Factors

To compare the accuracy of procalcitonin (PCT) in early-onset neonatal sepsis (EOS) using standard cut-off values and a multilevel probabilistic approach.. A retrospective study of PCT was performed in 149 newborns at risk of EOS, including preterm or prolonged rupture of membranes, chorioamnionitis or maternal infection, GBS colonization and signs of fetal distress. PCT values were analysed according to time of assay, i.e. at birth and at 24 and 48 h. We estimated sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR-), diagnostic odds ratio (DOR) and number needed to diagnose (NND) using traditional and optimal (derived from ROC analysis) PCT cut-off values.. Using optimal cut-off, the LR+, DOR and NND at birth were 10, 18.9 and 2.2, at 24 h they were 5.3, 11.2 and 2.1, and at 48 h they were 5.6, 18.1 and 1.7, respectively. The multilevel analysis generated three post-test probabilities for each time of assay. At 24 h post-test probabilities of EOS were 78% for PCT >90, 11% for PCT 10.1-90 and 3% for PCT <10.1 mg/L, respectively. Similar results were found in the other time points, with a wide range of intermediate PCT concentrations that did not change the post-test probability.. The multilevel probabilistic approach was more effective in assessing the diagnostic power of PCT in EOS, showing that a wide range of intermediate PCT values was not able to discriminate between presence and absence of infection.

Topics: Age of Onset; Biological Assay; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Infant, Newborn; Infant, Newborn, Diseases; Italy; Likelihood Functions; Models, Statistical; Protein Precursors; Risk Factors; ROC Curve; Sepsis

The goal of this study was to investigate the role of procalcitonin (PCT) in diagnosis of neonatal sepsis and its correlation with C-Reactive Protein (CRP). One hundred and seventeen neonates with the gestational age > or = 35 weeks with clinically suspected diagnosis of neonatal sepsis were studied during one year from 2007 in Tabriz Children's Hospital. Conventional sepsis workup was done in all cases and the diagnosis of neonatal sepsis was proved based on the results of blood culture. The serum procalcitonin was measured by quantitative Chemo-luminance methods and the results were compared with CRP levels between the neonates with and without proven sepsis. The results showed among in 117 neonates with suspected sepsis 27 (23.1%) cases have positive blood culture (proven sepsis). The mean levels of PCT in neonates with and without proven sepsis was 4.42 +/- 6.66 vs. 2.06 +/- 4.03 ng mL(-1) and CRP 33.98 +/- 36.81 vs. 12.30 +/- 20.42 mg L(-1) were significantly higher in neonates with proven sepsis (p = 0.026 and p < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of PCT (more than 2 ng mL(-1)) were 66.7, 50, 28.6, 83.3 and CRP (more than 3.5 mg L(-1)) were 70.4, 72.2, 43.2 and 89%, respectively, in diagnosis of neonatal sepsis. There was a meaningful correlation between the level of PCT and CRP in the sepsis group (r = 0.797, p < 0.001). The results of the current study showed that more relying on the level of PCT and CRP for planning the management of neonates with suspected sepsis is not logical, but a negative result may be helpful in ruling it out.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Luminescence; Male; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis

Sepsis is an important cause of mortality in newborns. However, a single reliable marker is not available for the diagnosis of neonatal late-onset sepsis (NLS). The aim of this study is to evaluate the value of serum amyloid A (SAA) and procalcitonin (PCT) in the diagnosis and follow-up of NLS.. 36 septic and healthy newborns were included in the study. However, SAA, PCT, TNF-alpha, IL-1beta, and CRP were serially measured on days 0, 4, and 8 in the patients and once in the controls. Töllner's sepsis score (TSS) was calculated for each patient.. CRP, PCT, and TNF-alpha levels in septic neonates at each study day were significantly higher than in the controls (P = .001). SAA and IL-1beta levels did not differ from healthy neonates. The sensitivity and specificity were 86.8% and 97.2% for PCT, 83.3% and 80.6% for TNF-alpha, 75% and 44.4% for SAA on day 0.. Present study suggests that CRP seems to be the most helpful indicator and PCT and TNF-alpha may be useful markers for the early diagnosis of NLS. However, SAA, IL-1beta, and TSS are not reliable markers for the diagnosis and follow-up of NLS.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Interleukin-1beta; Male; Pregnancy; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Serum Amyloid A Protein; Tumor Necrosis Factor-alpha

We evaluated the semi-quantitative procalcitonin level for diagnosing late-onset infections in 176 neonates. Using a cut-off level of 0.5 ng/ml, the sensitivity was 84.4%+/-0.19, specificity was 93.9%+/-0.04, positive predictive value was 82.6%+/-0.1, and negative predictive value was 94.6%+/-0.04. Procalcitonin could be a useful marker of late-onset infection in neonates.

Topics: Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Protein Precursors; Sensitivity and Specificity

It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin.. One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acute-care teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12-24 h and 36-48 h after the onset of symptoms was calculated by receiver-operating characteristics (ROC) curves. The Youden's index (sensitivity + specificity - 1) was used for determination of optimal cutoff values of the diagnostic tests in the different postnatal periods. Sensitivity, specificity, and the likelihood ratio of a positive and negative result with the 95% confidence interval (CI) were calculated.. The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12-24 h and 36-48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0.59 ng/mL at the time of suspicion of sepsis (sensitivity 81.4%, specificity 80.6%); 1.34 ng/mL within 12-24 h of birth (sensitivity 73.7%, specificity 80.6%), and 0.69 ng/mL within 36-48 h of birth (sensitivity 86.5%, specificity 72.7%).. Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be useful as part of a full sepsis evaluation.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cross Infection; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Spain

We evaluated procalcitonin (PCT) assay in the emergency diagnosis of neonatal bacterial infection, especially in preterm infants, relative to C-reactive protein (CRP) and fibrinogen.. One hundred and twenty neonates (32 preterm), of whom 21 were infected, were tested.. Concentrations of PCT, CRP and fibrinogen in uninfected infants were not affected by gestational age at birth. Concentrations of CRP and PCT increased rapidly during the first 24 h of life, while fibrinogen concentrations increased gradually from birth. All marker concentrations were significantly greater in neonates with bacterial infection. Receiver-operating characterstic analysis showed that optimum cut-off values for fibrinogen, CRP and PCT were 3.0 g/L, 7.5 mg/L and 2.5 microg/L respectively, for the diagnosis of sepsis at birth.. Determination of PCT is of value in excluding bacterial infection in neonates since it has a negative predictive value of 93%.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Fibrinogen; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Protein Precursors; ROC Curve; Sepsis

To determine accuracy of procalcitonin concentrations for diagnosing nosocomial infections in critically ill neonates.. Case-control study.. Neonatal intensive care unit of a teaching hospital.. Twenty-three neonates with nosocomial infection. Four controls matched for duration of hospital stay and birth date were chosen for each case patient.. PCT concentrations were measured by the LUMItest procalcitonin kit at onset of signs of infection and after recovery. Range of PCT concentrations (ng/ml) was 2.0 to 249.1 in case patients and 0.08 to 1.0 in controls (sensitivity and specificity, 100%). PCT values returned to normal (<1.0 ng/ml) by day 3 to 7 of appropriate antibiotic therapy.. Measurement of PCT concentrations may be useful for early diagnosis and monitoring of infectious complications in neonates during their stay in the neonatal intensive care unit.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Cross Infection; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Italy; Male; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis