Introduction: Neonatal sepsis is a leading cause of mortality and morbidity in developing countries. Blood culture is usually found to be negative due to the indiscriminate use of antibiotics. Procalcitonin (PCT) is a recently proposed specific marker of systemic inflammatory response to infection.
Objectives: To examine whether procalcitonin is a reliable diagnostic and prognostic indicator for culture-positive bacterial sepsis compared to conventional markers.
Methods: This was a prospective cohort study conducted in the Neonatal Intensive Care Unit of a tertiary care referral hospital. One hundred consecutive neonates with clinical diagnosis of sepsis were enrolled. Infants with congenital or chromosomal anomalies and metabolic disorders were excluded. Blood culture was done for all those included, who received antibiotics for a minimum of 48 hours. Total white blood cells count, platelets, absolute neutrophil count, immature-to-total neutrophil ratio, C-reactive protein (CRP) and Procalcitonin were done on Days 1, 3 and 7. Subjects were grouped into blood culture-positive (study group) and culture-negative (control group) and a suitable prognostic indicator was sought. The markers were also compared amongst various outcome groups as favorable versus unfavorable and survivors versus non-survivors. The data were analyzed statistically using SPSS software.
Results: Procalcitonin was a better marker than CRP and hematologic indices in differentiating culture-positive and culture-negative sepsis in the newborn (p-0.048, <0.001 and <0.001 for PCT on days 1, 3 and 7; Mann Whitney U Test). Procalcitonin values increased sequentially in those with an unfavorable outcome (p<0.001 for the difference in day 7 to 1 values) and decreased similarly (p<0.001 for difference in day 7 to 1 values) in those with a favorable outcome.
Conclusion: Procalcitonin was found to be a better marker for early diagnosis as well as prognosis as compared to other conventional markers in Neonatal Sepsis.
Keywords: Neonatal Sepsis, Newborn, Marker, Procalcitonin, Prognosis.
Anjali Kulkarni– Senior Consultant, Pediatrics and Neonatology, Department of Pediatrics, Bombay Hospital and Medical Research Centre, Mumbai, India
(Late) Sushma Kaul– Senior Consultant, Neonatology, Department of Pediatrics, Indraprastha Apollo Hospitals, New Delhi, India
Raman Sardana– Senior Consultant, Microbiology, Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India