Abstract
Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.
Highlights
On the other hand, prolonged or inadequate use of antibiotics is followed by adverse reactions and dysbiosis in the newborn
Procalcitonin (PCT), interleukins, pro-vasopressin, C-reactive protein (CRP) and myeloid cells expressing triggering receptor-1 (TREM-1) are biological markers used for diagnosing inflammatory response [3,6]
All the newborns included in the study had the following tests: complete blood count (CBC), CRP and presepsin taken at 24 hours of life and PCT at 48 h
Summary
The soluble form of CD14 (sCD14) is secreted directly by the hepatocytes: during protease inflammation, plasma activates a cleavage of sCD14 in order to generate a form called sCD14-truncated subtype (sCD14-ST), well known as of presepsin [13]. All the newborns included in the study had the following tests: complete blood count (CBC), CRP and presepsin taken at 24 hours of life and PCT at 48 h. Diagnosis of sepsis was established based on Tollner sepsis score (≥10) [19,20], applied to all newborns in the study from the first day of the symptoms. Tollner score is the first system of neonatal sepsis diagnosis which includes clinical parameters (coloration, peripheral circulation, hypotonia, apnea, respiratory distress, hepatomegaly, abdominal distension) and laboratory parameteres (leucocyte count, thrombocyte count, immature per total neutrophil index, metabolic acidosis). The suspicion of neonatal sepsis was based on clinical examination, risk factors and laboratory investigations. Risk factors associated with neonatal sepsis are rupture of membranes over 18 h , chorioamnionitis, invasive procedures (endotracheal intubation, peripherally inserted central catheter). We used Independent sample T test, ROC curve and two-tailed test was considered significant when p < 0.05
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