Early detection of neonatal sepsis, dilemma of diagnosis

Background and objectives: Accurate identification of neonatal sepsis is an increasing problem facing neonatologists due to non specific clinical signs with no existing single reliable marker of infection. Molecular assays for the detection of bacterial DNA in the blood represent possible diagnostic tools for early identification of bacterial causes. Procalcitonin [PCT] is a promising marker distinguishing between infection and inflammation which cannot be differentiated by acute phase proteins as C-reactive protein [CRP]. The aim of the study was to compare results of blood cultures with eubacterial PCR, PCT and CRP as early markers of neonatal sepsis

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Subjects and methods: In this study, neonates with clinically suspected sepsis admitted to neonatal intensive care unit [NICU] in Mansoura University Children Hospital were included. Based on blood culture positive results, they were divided into 2 groups: proven sepsis and clinical sepsis. Comparing the 2 groups, sensitivity and specificity for, PCR, PCT and CRP were evaluated. Using receiver operating characteristic [ROC] curves, threshold value for both PCT and CRP were estimated

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Results: Out of 141 neonates with clinically suspected sepsis, 56 (39.7%) were confirmed as proven sepsis. Compared to blood culture, the diagnosis of bacterial proven sepsis by PCR revealed 100 % sensitivity and 93% specificity. This study revealed that PCT >6.5 ng/ml had 83.9% sensitivity and 98.8% specificity, whereas CRP >3.5 mg/dl had 83.9%, sensitivity and 8l.2%specificity for diagnosing sepsis

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Conclusion: This study confirms the value of PCR and PCT as rapid diagnostic tools for early detection of neonatal sepsis?