Background: Neonatal sepsis is the cause of substantial morbidity and mortality. Clinically, little difference exists between sepsis secondary identified pathogen and that caused by an unknown pathogen. An ideal sepsis biomarker that has high diagnostic validity could allow early diagnosis and exclusion of neonatal sepsis, so that appropriate antibiotics can be started to neonate.
Objectives: To evaluate the value of early estimation of serum levels of primary-phase reactants as adjuvant to clinical scorings for early diagnosis of neonatal sepsis especially the early-onset sepsis (EOS).
Patients & Methods: 117 neonates with suspected EOS during their first week of life were evaluated clinically using the Score for Neonatal Acute Physiology (SNAP II) and venous blood samples were obtained prior to start of treatment for blood culture (BC) as gold standard for sepsis diagnosis and ELISA estimation of serum levels of primary-phase reactants; high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-6 and procalcitonin (PCT).
Results: BC confirmed EOS diagnosis in 60 neonates but EOS was doubtful in 21 neonates and 36 neonates were free of sepsis according to clinical severity and BC. At admission high serum PCT could differentiate between neonates with confirmed or suspected sepsis and statistical analyses defined high serum PCT as significant predictor for positive BC. Combined estimation of serum PCT and clinical scoring did better than reliance on estimation of serum levels of primary-phase reactants only for discrimination between cases with confirmed and suspected EOS.
Conclusion: Clinical evaluation using SNAP II score with estimation of serum PCT did well for differentiation between sepsis severity grades in neonates with suspected EOS and could define neonates with positive BC prior to culture result was obtained. In case of equivocal clinical findings high at admission serum levels of hsCRP, IL-6 and PCT measured in combination can help early diagnosis of EOS.
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