“Correlation of Procalcitonin With Sepsis Screen and Blood Culture in Neonatal Sepsis”

Abstract

BACKGROUND – Sepsis in neonates may be difcult to differentiate from other conditions, because the clinical signs are non-specic. It is a common cause of morbidity and mortality amongst neonates in NICU. Neonatal sepsis is a clinical syndrome which is accompanied by signs and symptoms of infection during rst 4 weeks of life. Neonatal mortality accounts for about 40% deaths under ve years of age. Global incidence of neonatal deaths caused by sepsis is only 15% but in a developing country like our sepsis accounts for about 30% -50% of neonatal mortality. Delay of even few hours in initiating treatment can increase mortality and morbidity considerably. AIMS AND OBJECTIVESAIM- To correlate procalcitonin with sepsis screen and blood culture in neonatal sepsis. OBJECTIVESA. To compare procalcitonin and CRP with culture positivity in diagnosing neonatal sepsis. B. To Determine sensitivity, specicity and predictive value of Procalcitonin as an indicator of neonatal sepsis in comparison with blood culture. C. To predict the value of altered WBC and platelet counts in diagnosing neonatal sepsis. D. To correlate culture proven sepsis with maturity of neonate, birth weight and mode of delivery. Material: 100 clinically suspected cases of Sepsis in neonates admitted to MMIMSR, Mullana, Ambala. Methods: All neonates who were suspected clinically as a case of sepsis based on sepsis score and categorized into (0- 72 hours PNL) EOS or LOS (>72hours PNL) depending on day of presentation of clinically suspected sepsis. Detailed history along with clinical ndings of neonates were noted. SERUM PROCALCITONIN, SEPSIS SCREEN with predetermined cut off values and during the same time blood culture was taken and sent. Depending on clinical condition CSF analysis, Urine analysis, Chest Xray were sent. Sensitivity, specicity and predictive values of procalcitonin, CRP and other parameters were assessed. RESULTS- In this study of 100 neonates with clinical suspicion of sepsis admitted in NICU in MMIMSR over a period of 16 months from JAN 2020 to JUNE 2021. Out of 100 cases of the number of male neonates included in this study was greater than the female neonates suggesting that in clinically suspected neonatal sepsis male neonates were affected more than female neonates. Out of 100 neonates 63 neonates were male (63%) and 37 were female (37%). Laboratory nding of positive blood culture of sepsis of male neonates is 10 (56%), whereas female neonates of positive blood culture of sepsis is 8 (44%). Culture positivity showed only a slight rise in male neonates than females which was not much of a difference. . About three-fold increase in culture positivity was seen in preterm neonates (55%) when compared to term neonates (19%). Laboratory nding of positive blood culture of SGA neonates is 10 (19%), AGA is 8 (17%). Culture positivity showed SGA neonates has greater sepsis cases than AGA neonates. Association of sepsis score with procalcitonin value. On applying regression analysis, we found there is no association with R square 0.004. Association of CRP value with procalcitonin value. On applying regression analysis, it was found very mild association with R square 0.028. shows Association of absolute leucocyte count value with procalcitonin value. On applying regression analysis, we found very mild association with R square 0.069. Association of blood culture with procalcitonin. On applying t test between positive and negative blood culture with procalcitonin value we found significant association of procalcitonin value (p value <0.05). CONCLUSION-In this study the risk factors commonly associated with neonatal sepsis were found to be LBW, VLBW, ELBW, Prematurity, LSCS, instrumental delivery that is assisted vaginal. delivery. EONS was more common than LONS. Procalcitonin was found to be a sensitive tool for diagnosis and it also helps predicting the outcome of sepsis as compared to CRP but it cannot be used as a sole marker as its neither 100% sensitive and it's not 100% specic. The predictability can be achieved by a combination of markers of neonatal sepsis rather than a single marker but as of now BLOOD CULTURE remains the gold standard in diagnosis of neonatal sepsis.