Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission

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.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%).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.Neonatal sepsis of vertical transmission remains a major problem associated with high morbidity and mortality in newborns, particularly amongst preterm infants [1-4]. Rapid diagnosis is problematic because the first signs of this disease may be minimal, and are similar to those of various non-infectious processes; furthermore, bacterial cultures are time-consuming, and other laboratory tests are either not available for routine use or lack sensitivity or specificity. In this situation, neonates with risk factors for infection or clinical suspicion of infection are empirically treated with antibiotics. To avoid the unn