Infection In Newborn Infants Research Articles

Implementation of pooled saliva tests for universal screening of cCMV infection.

Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to neurodevelopmental disabilities. Universal newborn infant screening of cCMV has been increasingly advocated. In the absence of a high-throughput screening test, which can identify all infected newborn infants, the development of an accurate and efficient testing strategy has remained an ongoing challenge. Here we assessed the implementation of pooled saliva polymerase chain reaction (PCR) tests for universal screening of cCMV, in two hospitals of Jerusalem from April 2022 through April 2023. During the 13-month study period, 15,805 infants (93.6% of all live newborn infants) were screened for cCMV using the pooled approach that has since become our routine screening method. The empirical efficiency of the pooling was six (number of tested newborn infants per test), thereby sparing 83% of the saliva tests. Only a minor 3.05 PCR cycle loss of sensitivity was observed for the pooled testing, in accordance with the theoretical prediction for an eight-sample pool. cCMV was identified in 54 newborn infants, with a birth prevalence of 3.4 per 1,000; 55.6% of infants identified with cCMV were asymptomatic at birth and would not have been otherwise targeted for screening. The study demonstrates the wide feasibility and benefits of pooled saliva testing as an efficient, cost-sparing and sensitive approach for universal screening of cCMV.

Traceability and Characteristic Investigation of Burkholderia Gladioli Bloodstream Infection in Patients with Hematologic Malignancies

*Drs. Mei Hong and Qiuling Wu are co-corresponding authors Background and aims: Bone marrow suppression and mucosal damage caused by high-dose chemotherapy, and the application of immunosuppressive agents after transplantation lead to immune deficiency of patients with hematologic malignancies, who are susceptibility to opportunistic pathogen infections . Burkholderia gladioli, widely known as B. cocovenenans in the public eye, is an extraordinary Burkholderia specie causing acute lethal food poisoning by producing toxoflavin (TF) and lethal bongkrekic acid (BA). It is also an opportunistic pathogen causing clinical infections in newborn infants and patients with cystic fibrosis, chronic granulomatous disease, mechanical ventilation and other immunocompromising conditions, but its source of infection and pathogenic mechanism are still not clear. This study investigated the source of B. gladioli bloodstream infection in patients with hematologic malignancies and demonstrated the antibiotic sensitivity, biological characteristics, and genetic characteristics of B. gladioli strains, providing guidance for clinical treatment and improving patient prognosis. Methods: Nanopore-targeted sequencing (NTS) was used to rapidly detect pathogens in the peripheral blood of patients, and MALDI-TOF MS was used to identify blood culture pathogens. Samples were taken from locations and things associated with patients including medical equipment, inpatient environment, food, and biological specimens. Multilocus sequence typing (MLST) analysis was used to detect the genotypes of B. gladioliDNA. The K-B assay was used to detect bacterial antibiotic sensitivity. The dilution-coated plate method was used in the in vitro phenotyping experiments. Whole-genome sequencing (WGS) was used for the identification and comparation of B. gladioli strains. Results: In this study, NTS and culture of peripheral blood were routinely carried out in patients with hematological malignancies when they gone through febrile neutropenia due to immune deficiency. When patients confirmed positive for B. gladioli bloodstream infection, traceability sampling and PCR verification were conducted from locations and things associated with patients including medical equipments, inpatient environments, food, and biological specimens. Results showed strong B. gladioli abundance in foods (rice, corn flour), but medical equipment and inpatient environment showed no B. gladioliexistence. Furthermore, MLST sequencing confirmed that B. gladiolibloodstream infections was originated from contaminated foods. More important, WGS analysis found that clinical B. gladioli strains isolated in this study were totally lacked of lethal bongkrekic acid (BA) gene clusters and partially lacked of the toxoflavin gene clusters. Antibiotic susceptibility tests revealed that the clinical strains were susceptible to cefazoxime, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole, cefalexin, cefoperazone/sulbactam, meropenem, imipenem, piperacillin/tazobactam, amikacin, tobramycin, minocycline hydrochloride, tigecycline and resistant to polymyxinB, ampicillin, cefazolin, cefuroxime, aztreonam, and cefoxitin. Phenotyping experiments found that B. gladioli strains didn't induce hemolysis but exhibited stronger thermal stability and ultraviolet (UV) stability compared with the standard B gladioli strain and lethal B gladioli strain. Conclusions: Foodborne B. gladioli strains in this study exhibited low toxicity and high thermal stability and caused opportunistic bloodstream infections of hematologic malignant patients in immunodeficient states, which deserves our attention. Its special biological characteristic might be attributed to whole and partial loss of toxigenic gene clusters. Clinical B gladioli strains are resistant to polymyxinB, but the standard B gladioli strain and lethal B gladioli strain are susceptible to it, indicating acquired resistance during colonization and empirical antibiotic therapy. Clinicians should strengthen the dietary management of inpatients to avoid the occurrence of foodborne infections.

SARS-CoV-2 infection in newborn infants: descriptive epidemiological analysis of cases reported to the Colombian national surveillance system during the first pandemic year, March 2020–February 2021

ObjectiveTo describe the clinical and epidemiological characteristics of newborn infants with SARS-CoV-2 infection notified in the Colombian Public Health Surveillance System.DesignThis epidemiological descriptive analysis was conducted using the data of...

Automated Complete Blood Cell Count Using Sysmex XN-9000® in the Diagnosis of Newborn Infection.

The early identification of septically infected newborn infants is important for ensuring good outcomes. Blood cell differentiations are helpful, but they are often time consuming and inaccurate. In this study, we evaluated the use of automatic white blood cell differentiations by flow cytometry for the diagnosis of neonatal sepsis. Episodes of suspected infection in neonates were retrospectively classified into two groups, unlikely infection (UI, levels of Interleukin-6 < 400 pg/mL or CRP within 48 h < 10 mg/L), n = 101 and probable infection (PI, Interleukin-6 ≥ 400 pg/mL or CRP within 48 h ≥ 10 mg/L), n = 98. Complete blood cell counts were performed by Sysmex XN-9000® using flow cytometry. Relative and absolute proportions of immature granulocytes were evaluated. Unexpectedly, the absolute count of immature granulocytes was significantly lower in the group of PI compared to UI neonates. Similar results were found when analysing the relative proportion of immature granulocytes among all neutrophil granulocytes. On the other hand, manually counted immature to total (I/T) ratios of granulocytes were higher in PI than in UI infants. Therefore, we conclude that differentiations of granulocytes by Sysmex XN-9000® can be used to distinguish between infected and uninfected neonates if the results are interpreted according to our findings. A low count of immature granulocytes as determined by Sysmex XN-9000® may indicate neonatal infection.

Prevalence, Risk Factors and Predictors of Mortality Outcome in Neonatal Sepsis in KSA: Systematic Review

The systemic reaction to infection in newborn infants during the first 28 days of life has been referred to as neonatal sepsis. Global health issues include neonatal sepsis. Furthermore, newborn sepsis contributes significantly to morbidity and mortality in underdeveloped nations. This study examined the prevalence, risk factors, aetiology, death rate, and outcomes of neonatal sepsis in newborns in the Kingdom of Saudi Arabia. On the same subject, a thorough search of the literature was done using online databases like PubMed, Embase, and Google Scholar. After removing 45 duplicates, a total of 119 articles were found in the initial systematic search. 25 studies were removed after title and abstract screening on 74 study papers. Only 16 papers out of 49 total items that underwent full-text evaluation met the requirements for inclusion in this meta-analysis. We took research that were released between January 1997 and December 2021. We only looked for English-language studies during our search. Neonatal sepsis is a major public health problem due to its rising occurrence; therefore, it is crucial to look at its epidemiology, risk factors, and clinical characteristics. Since gluten is now well recognised as a precipitating factor, current research is helping to better understand the other aspects of this syndrome.

Rhizobium Radiobacter Sepsis in a Neonate: A Case Report and Literature Review

Background: Rhizobium radiobacter, a gram-negative organism, rarely infects newborn infants, and the literature on the outcome of infants and treatment options is sparse. Case Presentation: We present a healthy preterm neonate infected with R. radiobacter and treated successfully. As the literature is limited in neonates, we performed the literature review of studies that reported R. radiobacter infection in the neonatal population. The systematic search on April 15, 2020, across PubMed, Web of Science, and Medline identified 5 case reports to date. The neonates in those reports were otherwise healthy without underlying risk factors, had infection limited to the bloodstream, treated successfully with cephalosporins, and aminoglycosides without any sequelae. Conclusion: R. radiobacter sepsis infection in newborn infants can occur without underlying risk factors and can be treated with common antibiotics, and the outcome of the infected neonates is favorable.

The course of new coronavirus infection in newborn infants

Introduction. To assess the features of the course of new coronavirus infection over the first month of life. Materials and methods. The article presents four clinical cases of coronavirus infection in newborn children aged 8 to 30 days, treated at the covid centre of the National Medical Research Center for Children’s Health. Results. The incubation period lasted from 2 to 10 days. The clinical picture included prevalence of hyperemic palatine arches, lethargy, impaired sucking, hyperemia of the conjunctiva, sneezing, mucous discharge from the nose, cough of varying severity. In more severe cases, an elevation in body temperature, a change in the auscultatory picture of lungs, abnormalities in the electrocardiogram. In the general blood test, there was noted anaemia, relative and absolute neutropenia, lymphocytosis and monocytosis; enlargement of activated partial thromboplastin time, increasing the level of D-dimer in the coagulogram. Computed tomography of the chest showed focal infiltrative changes in the lung tissue or uneven pneumatisation. Conclusion. Our observations show coronavirus infection in newborns, most often to show a mild and moderate course, which does not require the appointment of antibacterial drugs and hormonal, and anticoagulant therapy without strict indications. According to the recommendations of the World Health Organization, the mother, and baby should remain together throughout the day, regardless of the suspicion or confirmation of a viral infection. To date, there is no conclusive evidence mother-to-child transmission of COVID-19 through breastfeeding is possible, and the benefits of breastfeeding far outweigh the minimal risk of infection. In addition, IgA and IgG to SARS-CoV-2, detected in milk, neutralise the effect of the virus.

Pantoea Infections in the Neonatal Intensive Care Unit.

Pantoea is a plant pathogen infrequently reported to cause opportunistic bloodstream infections. This gram-negative bacillus is a rare cause of hospital-acquired infections in newborn infants with high mortality. Since the creation of the new genus Pantoea in 1989, the evidence base available to neonatal health care providers is limited. Most of the available literature consists of case reports and case series. This review aims to consolidate the current reported literature on Pantoea infections, focusing on newborn infants and the neonatal intensive care unit (NICU). Prematurity and the associated relative immunocompromised state are major risk factors for hospital-acquired infections due to Pantoea in newborn infants. Recent advances in molecular biology have improved our understanding of the cross-kingdom pathogenesis exhibited by Pantoea. Respiratory symptoms and association with central venous lines are the most common clinical presentation of Pantoea bacteremia in newborn infants. Early institution of appropriate antibiotic therapy against this organism could be lifesaving. Therefore, it is critical for neonatologists to understand the clinical spectrum of Pantoea infections in NICUs.

Cutaneous antisepsis for prevention of intravascular catheter-associated infection in newborn infants

Cutaneous antisepsis for prevention of intravascular catheter-associated infection in newborn infants

The Role for Intra-Partum Antibiotics in Previously GBS-Colonised Pregnancies, Not So Straightforward After All: A Case Study

Background: Group B Streptococcus (GBS) is the most frequent pathogen involved in early-onset infection in newborn infants. The incidence of early-onset GBS disease (EOGBS) is estimated at 0.4 and 0.57 per 1000 births in the United States of America and the United Kingdom respectively. It is clear that administration of intrapartum antibiotics (IAP) significantly reduces risk of EOGBS (RR 0.17, 95% CI 0.04 to 0.74; number needed to treat to benefit 25, 95% CI 14 to 100), hence institutes such as the Royal College of Obstetrics and Gynecology (RCOG), and American College of Obstetrics and Gynecology (ACOG), have released clinical practice guidelines (CPGs) with the aim to improve the standard of care in GBS screening and IAP for the prevention of EOGBS in neonates. CPGs guide clinicians in their management based on a consensus of care drawn from clinical evidence and offer a standard of care for them to fall back on to guard against medical malpractice litigation. However, deviation from the intended clinical context or the failure to recognize the limits of such guidelines could compromise patient safety. Aim: The aim of this case study is to highlight the role and limitations of clinical practice guidelines in medical practice, through a case of an early onset GBS infection in a neonate that was a result of selectively applying the RCOG and ACOG guidelines outside their intended context. Conclusion: The case illustrates the importance of applying guidelines correctly within the appropriate clinical context but serves also as a reminder for clinicians to understand the limitations of them when accounting for other co-conditions patients often present with in daily medical practice.

The Comparison of the Management Models for Identifying the Risk of Serious Bacterial Infection in Newborn Infants with a Newly Developed Scale

The Comparison of the Management Models for Identifying the Risk of Serious Bacterial Infection in Newborn Infants with a Newly Developed Scale

Assessment of C-Reactive Protein Diagnostic Test Accuracy for Late-Onset Infection in Newborn Infants

Rapid and accurate diagnosis of late-onset infection in newborn infants could inform treatment decisions and avoid unnecessary administration of antibiotics. To compare the accuracy of serum C-reactive protein (CRP) with that of microbiological blood culture for diagnosing late-onset infection in newborns. MEDLINE (1946-2019), Embase (1946-2019), and Science Citation Index (1900-2019) databases were searched for references (any language). The MeSH search terms included were "exp infant, newborn/" or "premature birth/" plus free text synonyms; and "C-reactive protein/" plus free text synonyms; and "exp sepsis/" or "exp bacterial infections/" plus free text synonyms. The proceedings from relevant conferences and references of identified papers were scrutinized. Authors were contacted to request missing data. Cohort and cross-sectional studies were included that compared the accuracy of serum CRP levels with microbiological culture results to diagnose late-onset (>72 hours after birth) infection in newborns (any gestational age) hospitalized after birth. Two reviewers assessed study eligibility. Among 10 394 records, 148 studies were assessed as full texts. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline extension for Diagnostic Test Accuracy (DTA) reviews was followed. Two reviewers assessed the method quality of each study using guidance from the Cochrane Screening and Diagnostic Test Methods Group (adapted from the Quality Assessment of Diagnostic Accuracy Studies 2). The primary meta-analysis outcome was diagnostic test accuracy of serum CRP level taken at initial investigation of an infant with suspected late-onset infection. The median specificity (proportion of true-negative results) and calculated pooled sensitivity (proportion of true-positive results) were determined by generating hierarchical summary receiver characteristic operating curves. In total, 22 studies with 2255 infants were included (sample size range, 11-590 infants). Participants in most studies were preterm (<37 weeks) or very low-birth weight (<1500 g) infants. Two studies additionally enrolled infants born at term. Most studies (16) used a prespecified CRP level cutoff for a "positive" index test (5-10 mg/L), and most studies (17) used the culture of a pathogenic microorganism from blood as the reference standard. Risk of bias was low with independent assessment of index and reference tests. At median specificity (0.74), pooled sensitivity was 0.62 (95% CI, 0.50-0.72). Adding serum CRP level to the assessment of an infant with a 40% pretest probability of late-onset infection (the median for the included studies) generated posttest probabilities of 26% for a negative test result and 61% for a positive test result. The findings suggest that determination of serum CRP level at initial evaluation of an infant with suspected late-onset infection is unlikely to aid early diagnosis or to select infants to undergo further investigation or treatment with antimicrobial therapy or other interventions.

C-reactive protein for diagnosing late-onset infection in newborn infants.

Late-onset infection is the most common serious complication associated with hospital care for newborn infants. Because confirming the diagnosis by microbiological culture typically takes 24 to 48 hours, the serum level of the inflammatory marker C-reactive protein (CRP) measured as part of the initial investigation is used as an adjunctive rapid test to guide management in infants with suspected late-onset infection. To determine the diagnostic accuracy of serum CRP measurement in detecting late-onset infection in newborn infants. We searched electronic databases (MEDLINE, Embase, and Science Citation Index to September 2017), conference proceedings, previous reviews, and the reference lists of retrieved articles. We included cohort and cross-sectional studies evaluating the diagnostic accuracy of serum CRP levels for the detection of late-onset infection (occurring more than 72 hours after birth) in newborn infants. Two review authors independently assessed eligibility for inclusion, evaluated the methodological quality of included studies, and extracted data to estimate diagnostic accuracy using hierarchical summary receiver operating characteristic (SROC) models. We assessed heterogeneity by examining variability of study estimates and overlap of the 95% confidence interval (CI) in forest plots of sensitivity and specificity. The search identified 20 studies (1615 infants). Most were small, single-centre, prospective cohort studies conducted in neonatal units in high- or middle-income countries since the late 1990s. Risk of bias in the included studies was generally low with independent assessment of index and reference tests. Most studies used a prespecified serum CRP threshold level as the definition of a 'positive' index test (typical cut-off level between 5 mg/L and 10 mg/L) and the culture of a pathogenic micro-organism from blood as the reference standard.At median specificity (0.74), sensitivity was 0.62 (95% CI 0.50 to 0.73). Heterogeneity was evident in the forest plots but it was not possible to conduct subgroup or meta-regression analyses by gestational ages, types of infection, or types of infecting micro-organism. Covariates for whether studies used a predefined threshold or not, and whether studies used a standard threshold of between 5 mg/L and 10 mg/L, were not statistically significant. The serum CRP level at initial evaluation of an infant with suspected late-onset infection is unlikely to be considered sufficiently accurate to aid early diagnosis or select infants to undergo further investigation or treatment with antimicrobial therapy or other interventions.

C-Reactive Protein for Diagnosing Late-Onset Infection in Newborn Infants: Systematic Review and Meta-Analysis

C-Reactive Protein for Diagnosing Late-Onset Infection in Newborn Infants: Systematic Review and Meta-Analysis

Antiviral Approaches for the Treatment of Herpes Simplex Virus Infections in Newborn Infants.

Herpes simplex virus (HSV) infections in newborns are associated with severe disease and death. Trials conducted by the Collaborative Antiviral Study Group have established the standard of care for the treatment of neonatal HSV disease with marked improvements in morbidity and mortality. We review the studies that have contributed to our understanding of the epidemiology and clinical course of neonatal HSV disease and discuss the landmark trials that have resulted in safe and effective treatment together with improved diagnostics. Although significant advances have been made, neonatal HSV disease continues to have an unacceptably high mortality rate with significant sequelae in survivors. Further research is urgently needed for prevention.

Early-onset neonatal infection in pregnancies with prelabor rupture of membranes in Kosovo: A major challenge

Objective:Prelabor rupture of membranes (PROM) is a common event in obstetrics that has a major impact in pregnancy outcome. This condition is linked to a number of pregnancy and birth complications with early-onset neonatal infection (EONI) being one of the major threats. This study was undertaken to determine the rate of neonatal infection in newborn infants with a maternal history of PROM and to evaluate the association of risk factors with neonatal infection following PROM.Materials and Methods:A cross-sectional descriptive design was used to analyze a population of 200 pregnant women presenting to the Obstetrics and Gynecology Tertiary Center in Kosovo (between 2013 and 2015) with PROM who gave birth to single newborns. Data including demographic characteristics, neonatal outcome, and risk factors for infectious neonatal morbidity were recorded and analyzed.Results:The study included 200 pregnant women with PROM and their newborns. Participant demographics included: the majority were young, aged between 20 and 29 years (67%), primiparous (67.5%), unemployed (92%), completed secondary level of education (83%), and with middle socioeconomic status (86%). Overall, 13% of the newborns had early-onset neonatal infection, and sepsis was proven in 5% of cases. Newborns of mothers with risk factors such as preterm (<37 weeks) PROM, low gestational weight at birth, prolonged rupture of membranes, maternal colonization, and low Appearance, Pulse, Grimace, Activity, Respiration score at birth had higher rates of infection compared with newborns of mothers without these risk factors.Conclusion:The rate of EONI in pregnancies complicated with PROM continues to be a global challenge in perinatology, and as this study reports, also a major challenge for Kosovo. Future research, revision and improvement on prenatal care and practices, timing of delivery, medical treatment, and prophylactic use of antibiotics in PROM are needed to reduce rates.

How do antimicrobial dressings compare with standard dressing for prevention of catheter-related infection in newborn infants with central venous catheters?

How do antimicrobial dressings compare with standard dressing for prevention of catheter-related infection in newborn infants with central venous catheters?

Early planned removal versus expectant management of peripherally inserted central catheters to prevent infection in newborn infants.

Duration of use may be a modifiable risk factor for central venous catheter-associated bloodstream infection in newborn infants. Early planned removal of peripherally inserted central catheters (PICCs) is recommended as a strategy to reduce the incidence of infection and its associated morbidity and mortality. To determine the effectiveness of early planned removal of PICCs (up to two weeks after insertion) compared to an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. We searched of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), Ovid MEDLINE, Embase, Maternity & Infant Care Database, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until April 2018), and conference proceedings and previous reviews. Randomised and quasi-randomised controlled trials that assessed the effect of early planned removal of umbilical venous catheters (up to two weeks after insertion) compared to an expectant management approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. Two review authors assessed trial eligibility independently. We planned to analyse any treatment effects in the individual trials and report the risk ratio and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals. We planned to use a fixed-effect model in meta-analyses and explore potential causes of heterogeneity in sensitivity analyses. We planned to assess the quality of evidence for the main comparison at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods. We did not identify any eligible randomised controlled trials. There are no trial data to guide practice regarding early planned removal versus expectant management of PICCs in newborn infants. A simple and pragmatic randomised controlled trial is needed to resolve the uncertainty about optimal management in this common and important clinical dilemma.

Genome-Wide Identification by Transposon Insertion Sequencing of Escherichia coli K1 Genes Essential for In Vitro Growth, Gastrointestinal Colonizing Capacity, and Survival in Serum

ABSTRACTEscherichia coli K1 strains are major causative agents of invasive disease of newborn infants. The age dependency of infection can be reproduced in neonatal rats. Colonization of the small intestine following oral administration of K1 bacteria leads rapidly to invasion of the blood circulation; bacteria that avoid capture by the mesenteric lymphatic system and evade antibacterial mechanisms in the blood may disseminate to cause organ-specific infections such as meningitis. Some E. coli K1 surface constituents, in particular the polysialic acid capsule, are known to contribute to invasive potential, but a comprehensive picture of the factors that determine the fully virulent phenotype has not emerged so far. We constructed a library and constituent sublibraries of ∼775,000 Tn5 transposon mutants of E. coli K1 strain A192PP and employed transposon-directed insertion site sequencing (TraDIS) to identify genes required for fitness for infection of 2-day-old rats. Transposon insertions were lacking in 357 genes following recovery on selective agar; these genes were considered essential for growth in nutrient-replete medium. Colonization of the midsection of the small intestine was facilitated by 167 E. coli K1 gene products. Restricted bacterial translocation across epithelial barriers precluded TraDIS analysis of gut-to-blood and blood-to-brain transits; 97 genes were required for survival in human serum. This study revealed that a large number of bacterial genes, many of which were not previously associated with systemic E. coli K1 infection, are required to realize full invasive potential.IMPORTANCE Escherichia coli K1 strains cause life-threatening infections in newborn infants. They are acquired from the mother at birth and colonize the small intestine, from where they invade the blood and central nervous system. It is difficult to obtain information from acutely ill patients that sheds light on physiological and bacterial factors determining invasive disease. Key aspects of naturally occurring age-dependent human infection can be reproduced in neonatal rats. Here, we employ transposon-directed insertion site sequencing to identify genes essential for the in vitro growth of E. coli K1 and genes that contribute to the colonization of susceptible rats. The presence of bottlenecks to invasion of the blood and cerebrospinal compartments precluded insertion site sequencing analysis, but we identified genes for survival in serum.

The diagnostic utility of procalcitonin, interleukin-6 and interleukin-8, and hyaluronic acid in the Norwegian consensus definition for early-onset neonatal sepsis (EONS).

IntroductionA key challenge in identifying serious bacterial infection in new born infants is the nonspecific clinical presentation of early-onset neonatal sepsis (EONS). Routinely used C-reactive protein, white blood cell count, and platelets are nonspecific. We assessed the diagnostic utility of single biomarkers or combinations of procalcitonin (PCT), interleukin (IL)-6, IL-8, and hyaluronic acid (HA) in newborn infant with EONS, and in human umbilical cord blood (HUCB) from deliveries with chorioamnionitis.Materials and methodsBlood was collected from term infants with strictly defined EONS (group 1, n=15), healthy term infants (group 2, n=15), and the umbilical vein from pregnancies with suspected chorioamnionitis (group 3, n=8), and from healthy pregnancies with no signs of infection (group 4, n=15).ResultsNeonatal plasma PCT and IL-8 showed good predictive value (90% and 83%) for EONS, and the combination of IL-6 or HA with PCT increased the predictability to 87% and 90%, respectively. PCT, IL-6, IL-8, and HA were 8.4-, 4.5-, 3.6-, and 1.9-fold higher when compared with plasma levels in noninfected neonates. PCT, IL-6, and IL-8 in HUCB predicted chorioamnionitis and fever in the delivering mother (89%, 83%, and 72%, respectively). HA was a poor predictor (59%), but its predictability increased in combination with PCT, IL-8, or IL-6. In HUCB from chorioamnionitic deliveries, IL-6, IL-8, and PCT were 23-, 14-, and 2.4-fold higher, respectively, when compared with HUCB from healthy deliveries. There was no correlation between C-reactive protein, white blood cell, and platelet count with PCT, IL-6, IL-8, or HA.ConclusionIn neonates that fulfilled the Norwegian consensus definition of neonatal sepsis, PCT, IL-6, and IL-8, but not HA, have the potential to improve our management of neonates at risk. Except for PCT and IL-8, both with a predictability of >80% in neonatal plasma, combinations of biomarkers increased the predictability for EONS and chorioamnionitis.