Diagnosis Of Early-onset Sepsis Research Articles

The Diagnostic Value of Progranulin in Early Onset Sepsis in Preterm Neonates

Abstract Background Neonatal sepsis is a leading cause of morbidity and mortality, especially in preterm Infants. It represents a deregulated host response to an infectious agent, resulting in multiple organ failure and long-term neurodevelopment delay. There is growing evidence that Progranulin is a promising biomarker in the early diagnosis of sepsis in neonates. Aim of the Work To assess the use of Progranulin as an early biomarker for detection of early onset sepsis in Preterm neonates and to detect whether Progranulin will provide us with earlier detection of EOS Than the usual used septic screen. Patients and Methods This was a case control study that was conducted in neonatal intensive care unit Department, Faculty of Medicine, Ain Shams university on 60 Neonates with early onset neonatal sepsis. Study groups were classified according to the blood culture into two groups: Group 1 (cases): 30 preterm neonates proved to have early onset sepsis with positive blood culture. Group 2 (control): 30 preterm neonates with negative blood culture. The study period was 6 months. Results PGRN levels were significantly elevated in the EARLY ONSET SEPSIS neonates compared with the levels in the non-EOS neonates (301.33 vs. 29.5 ng/ml (median), P < 0.001). Also, the receiver operating characteristic curve (ROC) showed that the best cut off point of PGRN (ng/mL) to detect Cases group was found to be > 50 with sensitivity of 100.0% and specificity of 100.0%. Conclusion Progranulin may can be used as a promising biomarker for the diagnosis of Early Onset Sepsis.

Evaluation of systemic inflammatory indices in the diagnosis of early onset neonatal sepsis in very low birth weight infants.

Previously, not six systemic inflammatory indices were evaluated in the diagnosis of early onset sepsis (EOS) in very low birth weight (VLBW, <1500g) premature infants. We evaluated the effectiveness of systemic inflammatory indices in the diagnosis of EOS in VLBW infants. Premature infants with birth weight <1500 g were included in the study. Six systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were compared in patients with EOS (treatment group) and without EOS (control group). Of 917 infants enrolled, 204 infants were in the EOS group and 713 infants comprised the control group. NLR, MLR and SIRI values were significantly higher in the EOS group than in the control group (p < 0.001). The AUC value of SIRI for the predictivity of EOS was 0.803. The SIRI can be used together with other parameters as both an easily accessible and the reliable systemic inflammatory indices in the diagnosis of EOS in VLBW preterm infants.

Application of Advanced Molecular Methods to Study Early-Onset Neonatal Sepsis.

Early-onset sepsis (EOS) is a global health issue, considered one of the primary causes of neonatal mortality. Diagnosis of EOS is challenging because its clinical signs are nonspecific, and blood culture, which is the current gold-standard diagnostic tool, has low sensitivity. Commonly used biomarkers for sepsis diagnosis, including C-reactive protein, procalcitonin, and interleukin-6, lack specificity for infection. Due to the disadvantages of blood culture and other common biomarkers, ongoing efforts are directed towards identifying innovative molecular approaches to diagnose neonates at risk of sepsis. This review aims to gather knowledge and recent research on these emerging molecular methods. PCR-based techniques and unrestricted techniques based on 16S rRNA sequencing and 16S-23S rRNA gene interspace region sequencing offer several advantages. Despite their potential, these approaches are not able to replace blood cultures due to several limitations; however, they may prove valuable as complementary tests in neonatal sepsis diagnosis. Several microRNAs have been evaluated and have been proposed as diagnostic biomarkers in EOS. T2 magnetic resonance and bioinformatic analysis have proposed potential biomarkers of neonatal sepsis, though further studies are essential to validate these findings.

Early Onset Sepsis in Neonates

Background Neonatal sepsis is one of the most important causes of neonatal morbidity and mortality. The most common risk factors associated with early onset sepsis (EOS) are preterm delivery, low birth weight, premature rupture of membranes, maternal urinary tract infection, Clinical manifestations of neonatal sepsis are nonspecific. These include temperature instability, respiratory distress, apnea, poor feeding, lethargy, irritability, convulsions, hypotonia, poor perfusion and abdominal distension Aim and objectives To describe epidemiology, demographic and incidence of early onset sepsis in neonate with risk factors at NICUS of Ain Shams University Hospitals. Subjects and methods This study is prospective cohort study, was carried out on 80 neonates with one or more maternal risk factors associated with EOS. Neonates will be completely evaluated and subsequently discriminated over the period of 1st 72hours of life in Neonates with risk factors for early-onset sepsis. diagnosis of EOS will be established based on the presence of any clinical evidence suggestive of sepsis, quantitatie C-reactive protein (CRP) levels ≥6 mg/dL, Rodwell’s hematological scores ≥3 and/or Tollner’s scores ≥ 10 with or without positive blood culture results, within the 1st 72 hours postnatal age. Result Among the studied maternal risk factors of neonatal sepsis in our study, 73.8% had PROM being the most common maternal risk factor for early neonatal sepsis followed by ceserian mode (C.S) of delivery 66.3%, and 26.2% had Chorioamintis. The gestational age was distributed as 36.76±3.01 with minimum 30 and maximum 42 weeks, of Ballard score 37.05±2.88 and weight was 2.87±0.82. 58.8% were females and 41.3% were males. Also, 42.5% of the studied group was preterm. 42.5% of studied group was diagnosed with sepsis. Conclusion Early diagnosis is important for early intervention and treatment. This diagnosis in neonates is usually based on clinical and laboratory findings.

Diagnostic Performance and Patient Outcomes With C-Reactive Protein Use in Early-Onset Sepsis Evaluations

To determine performance of C-reactive protein (CRP) in the diagnosis of early-onset sepsis, and to assess patient outcomes with and without routine use of CRP. This was a retrospective cohort study of infants admitted to 2 neonatal intensive care units. CRP was used routinely in early-onset sepsis evaluations during 2009-2014; this period was used to determine CRP performance at a cut-off of ≥10mg/L in diagnosis of culture-confirmed early-onset sepsis. Routine CRP use was discontinued during 2018-2020; outcomes among infants admitted during this period were compared with those in 2012-2014. From 2009 to 2014, 10 134 infants were admitted; 9103 (89.8%) had CRP and 7549 (74.5%) had blood culture obtained within 3days of birth. CRP obtained ±4hours from blood culture had a sensitivity of 41.7%, specificity 89.9%, and positive likelihood ratio 4.12 in diagnosis of early-onset sepsis. When obtained 24-72hours after blood culture, sensitivity of CRP increased (89.5%), but specificity (55.7%) and positive likelihood ratio (2.02) decreased. Comparing the periods with (n=4977) and without (n=5135) routine use of CRP, we observed lower rates of early-onset sepsis evaluation (74.5% vs 50.5%), antibiotic initiation (65.0% vs 50.8%), and antibiotic prolongation in the absence of early-onset sepsis (17.3% vs 7.2%) in the later period. Rate and timing of early-onset sepsis detection, transfer to a greater level of care, and in-hospital mortality were not different between periods. CRP diagnostic performance was not sufficient to guide decision-making in early-onset sepsis. Discontinuation of routine CRP use was not associated with differences in patient outcomes despite lower rates of antibiotic administration.

Diagnostic Accuracy of the Neonatal Early Onset Sepsis Calculator in Screening for Early Onset Sepsis in Neonates More Than 35 Weeks Age of Gestation

Background: Early-onset sepsis (EOS) is a leading cause of morbidity and mortality among neonates. Diagnosis of EOS can be difficult as clinical signs are subtle. The use of the Neonatal EOS Calculator (NEOSC) may help screen high-risk neonates for EOS and may result in a significant reduction in unnecessary antibiotic use. Objective: To determine the diagnostic accuracy of the NEOSC in screening for EOS in neonates more than 35 weeks age of gestation. Methodology: This was a retrospective, case-control study where 245 septic (cases) and 245 non-septic (controls) neonatal and maternal medical records were reviewed. The EOS risk classification from the NEOSC was compared with the actual clinical outcome. An online statistical software (medcalc.org) was used to compute for the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and accuracy of the NEOSC. Results: Based on the NEOSC, only 64 of 245 clinically septic neonates were truly positive for sepsis while 181 were falsely negative for sepsis. Of the 245 non-septic neonates, 3 were falsely positive for sepsis, while 242 were truly negative for sepsis. With a 95% confidence interval, the computed variables showed a Sn 26.12%, Sp 98.78%, PPV 76.12%, NPV 89.95%, PLR 21.33, and NLR 0.75. The accuracy of the NEOSC is 89.33%. Conclusion: The NEOSC had poor sensitivity and is not recommended in screening for EOS in neonates more than 35 weeks age of gestation. It may be used as an adjunct in EOS diagnosis due to its high specificity and accuracy.

The Correlation of Antibacterial Peptides Concentration in Umbilical Cord Blood and Early Onset Sepsis in Preterm Infants.

Umbilical cord blood from singleton preterm infants was collected during delivery, and the concentration of LL37 was measured. C-reactive protein (CRP), white blood cell count (WBC), platelets (PLT), and mean platelet volume (MPV) were determined within 3 days after birth. The differences in LL37, CRP, WBC, PLT, and MPV levels between the two groups were compared. Pearson correlation method was used to analyze the correlation between these factors. The early individual value of each detected index for early onset sepsis was analyzed by ROC curve. The level of LL37 in umbilical cord blood of sepsis group was significantly higher than those in the control group (383.85 ± 46.71 vs. 252.37 ± 83.30 ng/ml). Meanwhile, the levels of CRP, WBC, and MPV in the sepsis group were significantly higher than those in the control group (CRP:5.73 ± 4.19 vs. 2.50 ± 2.77 mg/L; WBC: 13.47 ± 12.35 vs. 6.83 ± 3.55 × 109/L; MPV: 11.20 ± 1.11 vs. 8.90 ± 0.68 fL), the level of PLT was significantly lower than those in the control group (PLT: 161.00 ± 38.51 vs. 241.50 ± 49.85 × 109/L) (P < 0.05). Pearson correlation analysis showed that the expression of LL37 was negatively correlated with PLT level (r = −0.9347, P < 0.0001), and positively correlated with MPV level (r = 0.9463, P < 0.0001). ROC curve analysis showed that the area under curve of LL37 for diagnosis of early onset sepsis was 0.875, the prediction probability was 0.7, the sensitivity was 90.0% and the specificity was 80.0%.

Utility of Umbilical Cord Blood Culture in the Diagnosis of Early Onset Sepsis: A Cross-sectional Study

Introduction: Umbilical cord is the first source of blood from the neonate. The clinical signs associated with sepsis are frequently non specific and subtle in the neonates making the diagnosis of infection difficult. Umbilical cord blood does not involve pain infliction, avoids iatrogenic blood loss and procedural complications. Aim: To evaluate the utility of Umbilical Cord Blood Culture (UCBC) in the diagnosis of Early Onset Sepsis (EOS). Materials and Methods: The present study was a crosssectional study carried out in neonatology unit of Department of Paediatrics, Rural Medical College, Loni, Maharashtra, India, for the period of mid-March 2021 to mid-September 2021. Neonates delivered in Rural Medical College to the mothers having the risk factors for EOS were included in this study. Informed consent was taken prior to start of study. Thus, 68 samples were collected and studied. UCBC was collected with all aseptic precautions immediately after the umbilical cord was cut after the birth of the baby, venous blood sample was collected within one hour of birth. The data was presented as count and percentages. Results: Majority were female neonates 40 (58.8%). On analysing maternal risk factors it was seen 8.8% had previous low birth weight and 13.2% had Rh negative status. Analysis for presence of risk factors for sepsis majority 79.4% were multiple times examined per vaginally, followed by 36.8% had foul smelling liquor, 11.8% had febrile illness and 5.8% had birth asphyxia. On umbilical cord culture and sensitivity, most common microorganism identified was Staphylococcus aureus 8 (11.8%), followed by 8.8% Pseudomonas species. So, present study shows that 35.3% (24 cases) had positive culture reports using utility of UCBC in 68 patients. Conclusion: Study concludes that umbilical cord blood sampling and culture can be used as a tool for diagnosing bacterial sepsis in neonates especially the high-risk neonates.

Eliminating Contamination in Umbilical Cord Blood Culture Sampling for Early-Onset Neonatal Sepsis.

Introduction: Despite the advantages of umbilical cord blood culture (UCBC) use for diagnosis of early onset sepsis (EOS), contamination rates have deterred neonatologists from its widespread use. We aimed to implement UCBC collection in a level III neonatal intensive care unit (NICU) and apply quality improvement (QI) methods to reduce contamination in the diagnosis of early onset sepsis.Methods: Single-center implementation study utilizing quality improvement methodology to achieve 0% contamination rate in UCBC samples using the Plan-Do-Study-Act (PDSA) model for improvement. UCBC was obtained in conjunction with peripheral blood cultures (PBC) in neonates admitted to the NICU due to maternal chorioamnionitis. Maternal and neonatal characteristics between clinical sepsis and asymptomatic groups were compared. Process, outcome, and balancing measures were monitored.Results: Eighty-two UCBC samples were collected in addition to peripheral blood culture from neonates admitted due to maternal chorioamnionitis. Ten (12%) neonates had a diagnosis of clinical sepsis. All PBCs were negative and 5 UCBCs were positive in the study period. After 2 PDSA cycles, there was special cause variation with improvement in the percent of contaminated samples from 7.3 to 0%. There was no change in antibiotic duration among asymptomatic neonates.Conclusions: Implementation of UCBC for the diagnosis of EOS in term infants is feasible and contamination can be minimized with the implementation of a core team of trained providers and a proper sterile technique without increasing antibiotic duration.

Procalcitonin in Preterm Neonates: A Different Threshold and Prolonged Interpretation.

Objectives: To evaluate the positive threshold of PCT for neonates of <32 weeks of gestation for the diagnosis of early-onset sepsis and to determine if the level of PCT collected within 6 h of life could be used.Design: Retrospective and bicentric study from May 2016 to April 2018.Setting: Two groups were established, neonates evaluated for PCT at birth (CordPCT) and within 6 h of life (delPCT).Patients: Two hundred and sixty neonates of <32 weeks of gestation born in Nice and South Paris (Bicêtre) University Hospitals, had been evaluated for PCT level.Main Outcomes Measures: The value of the PCT positive threshold was determined for the total population and each groups thanks ROC curves.Results: The threshold level of PCT for the total population was 0.98 ng/mL. The threshold value of cordPCT group was 1.00 vs. 0.98 ng/mL for delPCT group. The area under the Receiver Operating Characteristics curve for PCT sampled in delPCT group was significantly higher than in cordPCT group (0.94 compared to 0.75).Conclusions: The threshold level of PCT was higher in this cohort of neonates of <32 weeks of gestation compared to the value generally described for term neonates. The secondary sampling PCT level seems to be usable in screening algorithm for early-onset neonatal sepsis.

Serum Procalcitonin and C Reactive Protein in as early markers neonatal sepsis- A prospective study

Neonatal sepsis is one of the commonest causes of morbidity and mortality in neonates in India compared to the developed countries. Aim: To evaluate the Procalcitonin level this is an early marker in the diagnosis of neonatal sepsis and to assess the suitability of this test in the diagnosis of early-onset sepsis. Method: The prospective study was conducted in the Neonatal Division of Department of Pediatrics, Prathima Institute of Medical Sciences over a period of one year. The blood samples from 100 babies meeting the inclusion and exclusion criteria constituted the material for study. Result: Among the n=100 cases n=39 were procalcitonin positive, compared with gestational age 10 (43.5%) cases were positive with a gestation of &lt;37 weeks and 24 (31.2%) cases positive of cases &gt;37 weeks and there was no statistical significance concerning gestational age the association of material characteristics with procalcitonin positive and CRP positive levels. Blood culture was positive in n=9 (9%) of babies with (90% CI, 5.3-14.9) and negative in n=91 (91%) of babies with (90% CI, 85.2-94.7). Conclusion: A positive blood culture is the only definitive and gold standard for confirming a case of sepsis. Since the culture and sensitivity test requires a minimum period of 48 hours which is a precious time in deciding on the treatment of sepsis in the newborn. Rapid diagnosis by using Procalcitonin and CRP gives a reasonable degree of accuracy in diagnosing neonatal sepsis and will also guide antibiotic therapy. Procalcitonin in comparison with CRP has better sensitivity and hence can detect most cases of neonatal sepsis and better negative predictive value.

Cut-off value of white blood cell count in the diagnosis of early-onset sepsis in neonates

Objective To study the clinical significance and cut-off value of white blood cell (WBC) count in the diagnosis of early-onset sepsis (EOS) in neonates. Methods A retrospective analysis was performed on 306 neonates with EOS who were admitted from January 2019 to March 2020. A total of 580 children without infection who were admitted during the same period of time were enrolled as the control group. General status and WBC count were compared between the two groups. The diagnostic value of WBC count was analyzed based on the diagnostic and therapeutic protocol of neonatal sepsis in 2003 (referred to as the 2003 diagnostic and therapeutic protocol) and the expert consensus on the diagnosis and treatment of neonatal sepsis (2019 edition) (referred to as the 2019 expert consensus). Results According to the two different diagnosis and treatment protocols, the statistical analysis showed that WBC count had a relatively positive rate (51.3% and 32.0% respectively) but a relatively high specificity (93.3% and 98.6% respectively). The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of WBC count in the 2003 diagnostic and therapeutic protocol was larger than that in the 2019 expert consensus (P Conclusions The cut-off value of WBC ≥25×109/L in the 2003 diagnostic and therapeutic protocol is more reasonable in the diagnosis of EOS.

Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

BackgroundNeonatal sepsis is one of the major causes of death during the first month of life and early empirical treatment with injectable antibiotics is a life-saving intervention. Adherence to World Health Organisation guidelines on first line antibiotics is crucial to mitigate the risks of increased antimicrobial resistance. The aim of this paper was to evaluate if treatment of early onset neonatal sepsis in a low-income facility setting observe current guidelines and if compliance is influenced by contextual factors.MethodsThis cohort study used data on antimicrobial treatment of neonatal sepsis onset within 72 h of life from 12 regional hospitals participating in a scale-up trial of a neonatal resuscitation quality improvement package intervention in Nepal. Infants treated according to guidelines were compared with those receiving other antimicrobials. A multiple logistic regression analysis adjusted for the intervention and time trend was applied.Results1564 infants with a preliminary diagnosis of early onset sepsis were included. A majority (74.9%) were treated according to guidelines and adherence was increasing over time. Infants born at larger facilities (adjusted Odds Ratio 5.6), those that were inborn (adjusted Odds Ratio 1.97) or belonging to a family of dis-advantaged caste (adjusted Odds Ratio 2.15) had higher odds for treatment according to guidelines. A clinical presentation of lethargy or tachypnoea was associated with adherence to guidelines.ConclusionAdherence to guidelines for antibiotic treatment of early neonatal sepsis was moderately high in this low-income setting. Odds for observing guidelines increased with facility size, for inborn infants and if the family belonged to a dis-advantaged caste. Cefotaxime was a common alternative choice when guidelines were not followed, highly relevant for the risk of increased antimicrobial resistance.Trial registrationISRCTN, ISRCTN30829654, registered 17th of May, 2017.

Diagnostic accuracy of interleukin-6 for early-onset sepsis in preterm neonates

Background: Early-onset sepsis (EOS) is a leading cause of morbidity and mortality among neonates. Yet, accurate diagnosis remains a major challenge in clinical routine.Objective: The aim of this study was to evaluate the diagnostic accuracy of Interleukin-6 (IL-6) in combination with other objective perinatal data for early-onset sepsis (EOS) in preterm neonates.Methods: We conducted a retrospective nested case-control study with preterm neonates with a birth weight < 2000 g born in our NICU between January 2007 and June 2016. Differences of IL-6 levels and other perinatal clinical and laboratory data between neonates with and without EOS were statistically analyzed.Results: Sixty-seven preterm infants with and 115 neonates without EOS were included in this study. Specificity and sensitivity for IL-6 were 72.8% and 75.0%, respectively, with an area under the curve of 0.804 at a cut-off point of 40 ng/l. Depending on the statistical method applied, combining IL-6 with a second perinatal factor led either to an increase of specificity (82.4–100%) or sensitivity (75.0–92.2%).Conclusion: The combination of IL-6 with other perinatal factors can significantly increase specificity and sensitivity in the diagnosis of EOS. However, overall diagnostic accuracy cannot be notably improved as there is a tradeoff between sensitivity and specificity. Although these findings do not necessarily apply in clinical routine, they can be of substantial value in the assistance of individual decision making.

Mean platelet volume in preterm: a predictor of early onset neonatal sepsis

Background: Early onset sepsis (EOS) is potentially life-threatening problem especially in preterm. EOS diagnosis is challenging due to its non-specific signs and laboratory tests. Mean platelet volume (MPV) has been used as predictor of many inflammatory diseases. Objectives: To assess the correlation between serial MPV measurement and EOS occurrence in preterm infants and to determine MPV effectiveness in combination with C reactive protein (CRP) to diagnose EOS and mortality prediction. Methods: The study was carried out on 95 preterm infants with antenatal risk factor for EOS. Blood samples were taken for complete blood count (CBC) including MPV evaluated at birth (cord blood) and at 72 h of life. CRP analyzed on days 1 and 3, subsequently patients were identified in two groups: sepsis (n = 28) and no-sepsis (n = 67). Results: MPV was significantly higher on both day 1 (10.23 ± 0.92) fl and day 3 (10.77 ± 1.16) fL in the sepsis group compared with no-sepsis (8.11 ± 0.29) fl and (8.53 ± 0.42) fl, respectively. MPV of 8.6 fL was identified as cut off value in patients probably resulting in sepsis with a sensitivity of 97.14% and a specificity of 100%. MPV of 10.4 fl was determined as cut off value in patients possibly resulting in death with a sensitivity of 70% and a specificity of 82.5%. The combination of both MPV and CRP on day 1 resulted in improving performance of MPV with higher negative predictive value (93.1%) and higher sensitivity (80%). Conclusion: High cord blood and day 3 MPV can be used as surrogate marker for prediction of EOS and associated mortality in preterm neonates.

Evaluation of efficacy of septic screen in diagnosis of early onset sepsis

Background: Clinical features of sepsis are non-specific in all neonates and a high index of suspicion is required for the timely diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after 48-72 h. Therefore, a practical septic screen for the diagnosis of sepsis is needed. Objectives: To study the maternal and neonatal risk factors for early onset neonatal sepsis and to evaluate the efficacy of septic screen in diagnosis of same. Methods: Total 51 inborn were selected on basis of presence of maternal and neonatal risk factors, clinical features consistent with infection. The following investigations were done: Total leukocyte count, absolute neutrophil count, immature/total Neutrophil (I/T) ratio, haematocrit, platelet count, C-reactive protein (CRP) (after 6 h), gastric lavage, Micro erythrocyte sedimentation rate (ESR), chest X-ray (after 6 h). Blood culture was sent for any neonate with septic screen positive or those developing clinical sepsis within 72 h of birth and were correlated with the gold standard test (BACTEC). Results: Our study consisted of 51 inborn babies with 61% males and 39% females, 41% preterm &lt;37 weeks of gestation and 59% term, 64.7% low birth weight &lt;2500 g and 33% with history of premature rupture of membrane (PROM). Amongst 51 babies, 41.2% had leucocytosis, 15.7% with leucopenia, 21.6% had thrombocytopenia and 23.9% had anaemia. 86.3% had abnormal CRP, 33.3% had abnormal Micro ESR, and 54.9% had abnormal I/T ratio. Out of 51 babies, 17 (33.3%) were culture positive. Out of 17 culture proven sepsis, 64.7% were preterm, 88.8% were LBW &lt;2500 g and 64.7% had history of PROM. Out of 17 culture proven cases, 75% had leucopenia, 70% had abnormal I/T ratio. 58.8% had abnormal Micro ESR, 86% were CRP positive which suggest that leucopenia, CRP and Micro ESR are good septic screen markers. Gastric aspirate is less significant. Conclusion: PROM, prematurity and low birth weight, especially, very low birth weight are the common high risk factors for early onset sepsis. Amongst septic profile, leucopenia, CRP and Micro ESR are associated with culture proven sepsis.

Role of C-reactive protein in rapid diagnosis of early neonatal sepsis in a tertiary care hospital

Introduction: C-reactive protein (CRP) is a serum glycoprotein produced by the liver during acute inflammation. Because it disappears rapidly when inflammation subsides, its detection signifies the presence of a current inflammatory process. Serial measurements give information on the resolution or continuation of the inflammatory process. Recently, more sensitive immunoassay methods create a renewed interest of its utility in clinical practice. Early diagnosis of neonatal sepsis is often difficult. A prospective, cohort study was done in hospital born newborns to find out utility of CRP for early diagnosis of early onset sepsis for a period of one year from July 2013 to June 2014 in a tertiary care hospital. Method: Serum CRP was measured by immunoturbidity method at birth, at 24 hours and at 48 hours of age of suspected sepsis. Results: Out of 298 babies, 15(5.03%) were found with probable sepsis in presence of symptoms and/or positive sepsis screen. Blood culture was positive in 7 (46.66%) cases of probable sepsis. Our study shows that elevated CRP (>6mg/L) is associated with maternal risk factors, but not significantly correlated with culture proven EOS. It showed high sensitivity, low specificity, low positive predictive value and high negative predictive value as 93.3%, 44.9%, 8.2% and 99.2% respectively. When combined with other components of sepsis screen including ANC 0.2 or TLC<5000/cu.mm, its specificity significantly increases. Conclusion: In combination with other sepsis screen, it can be used as an early diagnostic tool. Lower levels (<6 mg/l) are helpful in excluding sepsis.

Efficacy of new leukocyte parameters versus serum C-reactive protein, procalcitonin, and interleukin-6 in the diagnosis of neonatal sepsis.

The aim of this study was to investigate and compare the efficacy of the new leukocyte parameters mean neutrophil and monocyte volume (MNV, MMV), conductivity (MNC, MMC), scattering (MNS, MMS) and volume distribution width (NDW, MDW) with serum C-reactive protein (CRP), procalcitonin (PC) and interleukin (IL)-6 in the diagnosis of neonatal sepsis. A total of 227 newborns (132 boys, 95 girls) were analyzed. There were 116 infants in the sepsis group (proven sepsis, n = 40; clinical sepsis, n = 76) and 111 in the control group. Venous blood samples were collected from infants at the time of diagnosis and complete blood count, peripheral blood smear, blood cultures, CRP, PC, IL-6 and MNV, MMV, MNC, MMC, MNS, MMS, NDW, and MDW were analyzed. MNV, NDW, MMV and, MDW were higher in infants with sepsis than in controls (P < 0.05 for all). MNS was lower in the patients with sepsis (P = 0.002). There was no significant difference between the sepsis and control groups in terms of MNC, MMC and MMS. Although the predictive value of leukocyte parameters including neutrophil and monocyte volume, conductivity, scattering and volume distribution width in the diagnosis of neonatal sepsis was lower than that of CRP, PC and IL-6, some of these new parameters may be useful in the differential diagnosis of newborn sepsis, along with the other screening tools. In particular, MNV seems to be the most useful parameter with the highest specificity; also, the importance of PC in the diagnosis of early onset sepsis was confirmed.

Role of C-Reactive Protein (CRP) as a screening tool in early diagnosis of neonatal septicemia

Background: Neonatal septicemia refers to generalized bacterial infection of neonate, which includes septicemia, pneumonia and meningitis. In developing countries one of leading factors for neonatal morbidity and mortality is bacterial sepsis. Aim: Early diagnosis of sepsis in the neonate is often difficult because symptoms and signs are usually non-specific. This study was conducted to evaluate C-reactive protein (CRP) as a screening tool for neonatal sepsis. Material and Methods: The study was conducted in Neonatal Intensive Care Unit in collaboration with Biochemistry Department at Guru Gobind Singh Medical College and Hospital, Faridkot from November 2013 to August 2014. 50 neonates were included with the age group of first 28days (4week) of life (infant age) in study. All of which were suspected to have sepsis in clinical settings. Patient with suspected sepsis having two or more of the following clinical features were used to identify patients: Respiratory and cardiovascular compromise, metabolic and neurologic changes. Blood samples were drawn prior to administration of antibiotic therapy on day one of admission for blood culture and CRP by trained staff with all aseptic precautions. Sample for blood culture was taken in blood culture bottle and the growth of bacteria was observed for 5 days after that they were reported and for CRP the investigation was performed by immunometric assay. Absolute neutrophil count and total leucocyte count was done by fully automated cell counter. Results: Among 50 septic screens, 39 (52%) patients had positive cultures, the sensitivity and specificity of ANC (Absolute Neutrophil Count) was 75% and 65.34%, TLC (Total Leucocyte Count) was 62% and 70.41%, CRP was 90 % and 83.21% respectively. This study also found that premature and low birth weight babies are more prone to neonatal sepsis. Conclusion: CRP is one of the most widely available, most studied, and most used laboratory tests for neonatal bacterial infection, and despite the continuing emergence of new infection markers, it still plays a central role in the diagnosis of early-onset sepsis of the neonate.

Cord blood procalcitonin and Interleukin-6 are highly sensitive and specific in the prediction of early-onset sepsis in preterm infants

We studied the predictive value of cord blood procalcitonin (PCT) and interleukin-6 (IL-6) in the diagnosis of early-onset sepsis (EOS) in the preterm infant. Retrospectively, PCT and IL-6 were correlated with clinical and/or blood culture positive EOS and negative infectious status between February 2008 and March 2011. Receiver operating curves (ROC) were generated and the area under the curve (AUC) was calculated by use of Youden's Index to detect the best cut-off values for sensitivity and specificity. Thirty of 218 preterm infants (13.8%) were diagnosed as having EOS. The optimal cut-off value for PCT was 0.235 μg/L (sensitivity 78.6%, specificity 86.3%), and for IL-6 15.85 ng/L (sensitivity 73.7%, specificity 84.2%), the combination of PCT and IL-6 revealed sensitivity 77.1% and specificity 91.7%. The combined determination of PCT and IL-6 from cord blood was highly sensitive and specific in the prediction of EOS.