Value of Monitoring Serum Procalcitonin in Neonates at Risk of Infection

Koskenvuo, Minna; Irjala, Kerttu; Kinnala, Anne; Ruuskanen, Olli; Kero, Pentti

doi:10.1007/s10096-003-0941-3

Cited by 11 publications

(8 citation statements)

References 9 publications

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“…From the small number of infected infants in our study, all samples of group 1 and nine of 12 samples of group 2, taken after birth, were higher than the proposed nomograms. In contrast with other studies, 20 23 24 oxygen dependency was not found to influence PCT concentrations independently. However, as only six infants in our cohort had severe hypoxia (FIO 2 .0.5), our results may be flawed, and therefore high concentrations of PCT in severely hypoxic preterm infants should be analysed with caution because of the probable influence of hypoxia previously found.…”

Section: Discussioncontrasting

confidence: 91%

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

Turner

Hammerman²,

Rudensky³

et al. 2006

Archives of Disease in Childhood - Fetal and Neonatal Edition

110

109

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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.

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Section: Discussioncontrasting

confidence: 91%

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

Turner

Hammerman²,

Rudensky³

et al. 2006

Archives of Disease in Childhood - Fetal and Neonatal Edition

110

109

View full text Add to dashboard Cite

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“…The study design was prospective for both neonatal and paediatric age, with the only exception of a retrospective cross-sectional study [45] in the neonatal age group. The setting of the studies was uniform, being mostly neonatal or paediatric intensive care units, with the exception of four studies [41, 45, 49, 51] in which patients were treated in hospital wards. Most of the studies (15 out of 17) used a qualitative semi-manual PCT assay.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of serum procalcitonin for the diagnosis of sepsis in neonates and children with systemic inflammatory syndrome: a meta-analysis

et al. 2017

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BackgroundA number of biomarkers have been studied for the diagnosis of sepsis in paediatrics, but no gold standard has been identified. Procalcitonin (PCT) was demonstrated to be an accurate biomarker for the diagnosis of sepsis in adults and showed to be promising in paediatrics. Our study reviewed the diagnostic accuracy of PCT as an early biomarker of sepsis in neonates and children with suspected sepsis.MethodsA comprehensive literature search was carried out in Medline/Pubmed, Embase, ISI Web of Science, CINAHL and Cochrane Library, for studies assessing PCT accuracy in the diagnosis of sepsis in children and neonates with suspected sepsis. Studies in which the presence of infection had been confirmed microbiologically or classified as “probable” by chart review were included. Studies comparing patients to healthy subjects were excluded. We analysed data on neonates and children separately.Our primary outcome was the diagnostic accuracy of PCT at the cut-off of 2-2.5 ng/ml, while as secondary outcomes we analysed PCT cut-offs <2 ng/ml and >2.5 ng/ml. Pooled sensitivities and specificities were calculated by a bivariate meta-analysis and heterogeneity was graphically evaluated.ResultsWe included 17 studies, with a total of 1408 patients (1086 neonates and 322 children). Studies on neonates with early onset sepsis (EOS) and late onset sepsis (LOS) were grouped together. In the neonatal group, we calculated a sensitivity of 0.85, confidence interval (CI) (0.76; 0.90) and specificity of 0.54, CI (0.38; 0.70) at the PCT cut-off of 2.0-2.5 ng/ml. In the paediatric group it was not possible to undertake a pooled analysis at the PCT cut-off of 2.0-2.5 ng/ml, due to the paucity of the studies.ConclusionsPCT shows a moderate accuracy for the diagnosis of sepsis in neonates with suspected sepsis at the cut-off of 2.0-2.5 ng/ml. More studies with high methodological quality are warranted, particularly in neonates, studies considering EOS and LOS separately are needed to improve specificity.Trial registrationPROSPERO Identifier: CRD42016033809. Registered 30 Jan 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2396-7) contains supplementary material, which is available to authorized users.

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“…Some studies have shown that PCT is more reliable than CRP as a test for the diagnosis of early-onset neonatal sepsis [13-15], but other studies have not found any advantage of PCT over CRP [11,23-25]. However, it is important to consider that large sample sizes are needed to assess differences in the accuracy of diagnostic tests, e.g., according to an estimated 25% prevalence of sepsis and an absolute difference of 15% between sensitivities of PCT and CRP, approximately 300 patients would be needed for 80% statistical power.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission

et al. 2007

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BackgroundThe results of recent studies suggest the usefulness of PCT for early diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to determine the behavior of serum PCT concentrations in both uninfected and infected neonates, and to assess the value of this marker for diagnosis of neonatal sepsis of vertical transmission.MethodsPCT was measured in 827 blood samples collected prospectively from 317 neonates admitted to 13 acute-care teaching hospitals in Spain over one year. Serum PCT concentrations were determined by a specific immunoluminometric assay. The diagnostic efficacy of PCT at birth and within 12–24 h and 36–48 h of life was evaluated calculating the sensitivity, specificity, and likelihood ratio of positive and negative results.Results169 asymptomatic newborns and 148 symptomatic newborns (confirmed vertical sepsis: 31, vertical clinical sepsis: 38, non-infectious diseases: 79) were studied. In asymptomatic neonates, PCT values at 12–24 h were significantly higher than at birth and at 36–48 h of life. Resuscitation at birth and chorioamnionitis were independently associated to PCT values. Neonates with confirmed vertical sepsis showed significantly higher PCT values than those with clinical sepsis. PCT thresholds for the diagnosis of sepsis were 0.55 ng/mL at birth (sensitivity 75.4%, specificity 72.3%); 4.7 ng/mL within 12–24 h of life (sensitivity 73.8%, specificity 80.8%); and 1.7 ng/mL within 36–48 h of life (sensitivity 77.6%, specificity 79.2%).ConclusionSerum PCT was moderately useful for the detection of sepsis of vertical transmission, and its reliability as a maker of bacterial infection requires specific cutoff values for each evaluation point over the first 48 h of life.

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Value of Monitoring Serum Procalcitonin in Neonates at Risk of Infection

Cited by 11 publications

References 9 publications

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

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

Accuracy of serum procalcitonin for the diagnosis of sepsis in neonates and children with systemic inflammatory syndrome: a meta-analysis

Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission

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