Procalcitonin in preterm infants during the first few days of life: introducing an age related nomogram

Abstract

Objective: To determine normal concentrations of procalcitonin in preterm infants shortly after birth and to assess its accuracy in detecting bacterial infection. Methods: Blood samples of 100 preterm infants were prospectively drawn during the first 4 days of life for determination of procalcitonin concentration. Infants were classified into four groups according to their sepsis status. Results: Mean (SD) gestational age and birth weight were 32 (2.9) weeks and 1682 (500) g respectively. A total of 283 procalcitonin concentrations from healthy infants were plotted to construct nomograms of physiologically raised procalcitonin concentration after birth, stratified by two groups to 24-30 and 31-36 weeks gestation. The peak 95th centile procalcitonin concentration was plotted at 28 hours of age; values return to normal after 4 days of life. Only 12 infants were infected, and 13 of their 16 procalcitonin concentrations after birth were higher than the 95th centile, whereas samples taken at birth were lower. In a multivariable analysis, gestational age, premature rupture of membrane, and sepsis status influenced procalcitonin concentration independently, but maternal infection status did not. Conclusions:The suggested neonatal nomograms of preterm infants are different from those of term infants. Procalcitonin concentrations exceeding the 95th centile may be helpful in detecting congenital infection, but not at birth.

Population pharmacokinetics and pharmacodynamics of teicoplanin in neonates: making better use of C-reactive protein to deliver individualized therapy

“…Its value in neonates is limited by a marked physiological increase after birth. 37 The ability to link drug concentrations with a biomarker provides the prospect for truly individualized therapy where the dosing of drug is designed to manage a biomarker rather than a serum drug concentration. However, there are some limitations.…”

‘Haptoglobin concentrations in preterm and term newborns’

“…Procalcitonin, for example, has a peak value that occurs >24 h after birth, and values then decrease after 48 to 72 h of life in both PT and T neonates. 17 Our study focused on newborns without hemolysis or infection who were born at our institution and remained hospitalized shortly after birth. Only PT babies remained in the hospital beyond the first 72 h of life because of feeding and social-related issues, therefore, the lack of a group of T babies in our study with available samples at weeks 1 to 2.…”

Relevance of Procalcitonin for the Diagnosis of Early and Late-Onset Sepsis in Newborns

“…Other authors found different results: Lopez Sastre et al [34] and Perez Solis et al [35] conclude moderate interest in the PCT, but do not compare to the CRP, the result of the Youden index in the study Lopez Sastre et al is lower than in our study (0.62 versus 0.75). Turner et al [21] found a similar interest of PCT and CRP, but this study with a methodology and a population different from ours. Isidor et al [36], with a semi-quantitative method, found values close to our study (likelihood ratio 14.9 and 0.09 versus 20.7 and 0.2).…”

“…However, it is well established that PCT concentrations in the neonate show a physiological increase during the first two days of life, which complicates the interpretation of results during this period; CHIESA present the results of work on the kinetics postnatal of the PCT with distribution of PCT values obtained for uninfected and EONS patients between birth and 48 hours of age [9]. Turner [21] study PCT concentration of uninfected and EONS preterm infants between birth and 96 hours of age, with 2 groups to 24-30 and 31-36 weeks gestation; results of these two groups are different.…”