Research article

Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission

José B López Sastre¹ , David Pérez Solís¹ , Vicente Roqués Serradilla² , Belén Fernández Colomer¹ and Gil D Coto Cotallo¹ for Grupo de Hospitales Castrillo³

¹Service of Neonatology, Hospital Universitario Central de Asturias, Oviedo, Spain

²Service of Neonatology, Hospital Universitario La Fe, Valencia, Spain

³Grupo de Hospitales Castrillo. Service of Neonatology, Hospital Universitario Central de Asturias, Oviedo, Spain

author email corresponding author email

BMC Pediatrics 2007, 7:9doi:10.1186/1471-2431-7-9

Published:	26 February 2007

Abstract

Background

The 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.

Methods

PCT 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.

Results

169 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%).

Conclusion

Serum 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.