Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis

Abstract

Context: The incidence of early-onset neonatal infection has greatly decreased, but a new diagnostic approach is needed to avoid overdiagnosis and overtreatment. The aim of this study was to assess the potential impact of an algorithm incorporating umbilical-cord-blood procalcitonin (PCT) level on neonatal antibiotics prescription rate as compared with current practice. Material and methods: We conducted a prospective study in three maternity wards in France. All term and preterm neonates with the usual risk factors for neonatal group B Streptococcus infection were eligible for umbilical-cord-blood PCT testing. We compared the proportion of neonates who were exposed early to antibiotics (before 6 days of life) to that of neonates for whom antibiotics prescription would be indicated according to the PCT-based algorithm. Results: Among the 3,080 neonates included, 1 neonate presented with certain infection and 38 neonates with probable infection. The global antibiotics prescription rate was 4.6% [95% confidence interval (CI), 4.1-5]. With the PCT-based algorithm, the potential decrease in prescription rate would be 1.8% (95% CI, 1.3-2.3), corresponding to a 39% (95% CI, 37.3-40.7) relative reduction in antibiotics exposure (p < 0.05). Conclusion: These results suggest that the umbilical-cord-blood PCT-based algorithm could significantly help the clinicians in their antibiotic prescription decision to decrease neonatal antibiotics exposure as compared with current practice. If validated in a larger interventional randomized study, this approach could help clinicians stratify the risk of early-onset neonatal infection and initiate early antibiotics treatment in newborns at high risk of infection while limiting the deleterious effects of useless prescriptions in non-infected newborns.

Diagnostic Utility of Cord Blood Serum Procalcitonin in Early Onset Neonatal Sepsis in Comparision to Sepsis Screening Parameters

“…Serum procalcitonin levels (PCT) in Group 1 subjects in relation to sepsis screen and blood culture in Olivia Oria de et al reported that in 'no sepsis' neonates' serum PCT was positive in 4.77% while 100% probable sepsis & proven sepsis neonates were PCT positive [18]. Similar results noted in Noemie Huetz et al study [19].…”

“…The higher value of PCT positive newborns in positive PSS subjects in our study is most probably due to high number of preterm and low birth weight. Olivia Oria de et al study reported that serum PCT levels were negative in 120 (88.23%) & positive in 16 (11.77%) subjects, out of 136 subjects [18] Relationship in Serum procalcitonin levels (PCT) and sepsis screen reported by Noemie Huetz et al as 57 subjects had serum PCT levels ≥0.6 ng/ml with positive sepsis screen in 16(28.07%) and negative in 41(71.93%) & serum PCT levels < 0.6 ng/ml in 3023 subjects, with positive sepsis screen in 23(0.76%) and negative in 3000 (99.24 %), other studies also depicted similar results [7,19,25,26,29]. Variations in the results of studies by different workers are due to respective cut-off values.…”

“…In our study higher results of positive sepsis screen are due to higher proportion of preterm subjects (35.22%), higher percentage of highrisk perinatal sepsis score (PSS>2) subjects (37.66%), and various maternal factors like poor nutrition, anemia, low maternal education, and low socioeconomic status. Other studies [7,19] report low positive sepsis screen, but these studies were done in developed countries having better socioeconomic status of families.…”

“…Olivia Oria de et al study reported no sepsis, probable sepsis and proven sepsis in 92.64%,5.88% and 1.48% neonates; and Noemie Huetz et al study reorted 98.74%,1.23%,0.03% respectively [18,19]. The higher number of no sepsis neonates, lower number of probable and proven sepsis neonates in these studies re ects overall higher quality of health services, higher maternal education, good health education and high socioeconomic status.…”

Umbilical Cord Procalcitonin to Detect Early-Onset Sepsis in Newborns: A Promising Biomarker

“…Umbilical cord sampling precedes this physiological peak and has shown to be a reliable method to aid decision making in an early stage (21). Recently, it has been shown that an umbilical cord PCTbased algorithm has the potential to decrease the number of preterm newborns that receive antibiotic therapy (22). Until now, no study has focused on the potential difference between venous umbilical cord blood, which originates from the mother or placenta, and arterial cord blood, originating from the newborn.…”