Is procalcitonin to C-reactive protein ratio useful for the detection of late onset neonatal sepsis?

Procalcitonin (PCT) has been reported as a sensitive marker for neonatal bacterial infections. Recently, small numbers of studies reported usefulness of PCT/C-reactive protein (CRP) ratio in detection of infectious conditions in adults. Thus, we conducted this study to evaluate PCT/CRP ratio in late onset neonatal sepsis. Serum PCT and CRP was measured in blood samples from 7 to 60 days after birth in 106 of neonates with late onset sepsis and 212 of controls who were matched with gestational age, postnatal age, birth weight, and gender. Areas under ROC curve (AUC) were calculated, and pairwise comparisons between ROC curves were performed. As a result, CRP (AUC 0.96) showed best performance in detection of sepsis from healthy controls compared with PCT (AUC 0.87) and PCT/CRP ratio (AUC 0.62); CRP > PCT > PCT/CRP ratio in pairwise comparison (p < .001). Both of CRP (AUC 0.94) and PCT (AUC 0.96) were found to discriminate proven sepsis from healthy controls compared with PCT/CRP ratio (AUC 0.54); CRP = PCT > PCT/CRP ratio in pairwise comparison (p < .001). However, in the detection of blood culture proven sepsis from suspected sepsis, PCT (AUC 0.70), and PCT/CRP ratio (AUC 0.73) showed better performance compared with CRP (AUC 0.51); PCT = PCT/CRP ratio > CRP in pairwise comparison (p < .001 and p = .006, respectively). In conclusion, CRP and PCT showed good performance in discrimination between sepsis and healthy controls. However, PCT/CRP ratio seems to be helpful in distinguishing proven sepsis from suspected sepsis together with PCT. Further studies are warranted to elucidate the efficacy of PCT/CRP ratio with enrollment of enough numbers of infants.

Comparisons of proteomic profiles of whey protein between donor human milk collected earlier than 3 months and 6 months after delivery.

BACKGROUND AND OBJECTIVES: Human milk has nutritional, protective, and developmental advantages for premature infants. However, proteomic information of low abundant protein of donor milk is insufficient. The purpose of this study is to analyze and compare the proteome of low abundant protein of donor milk obtained at different postpartum ages other than the colostrum. METHODS AND STUDY DESIGN: Donor breast milk from 12 healthy mothers was collected 15 days, 2 months and 6 months after delivery and stored by medically approved methods. The whey milk proteomes were analyzed by mass spectrometry and classified using bioinformatics analysis. RESULTS: Human milk obtained 15 days and 2 months after delivery showed more abundant expression of whey proteins related to the generation of precursor metabolites and energy, metabolism, and catalytic activity, compared with milk collected at 3 months. Immune and transport-related proteins were abundant at all time points. Proteins involved in cellular movement, immune cell trafficking, and the carbohydrate metabolism network was more abundant in whey milk collected at 15 day and 2 months using a network analysis. CONCLUSIONS: We report proteomic information for human donor whey protein. As significant changes were found in whey proteome collected earlier than 2 months and 6 months after delivery, selecting human donor milk earlier than 2 months might be more helpful for early postnatal recipients.

Do gender and birth height of infant affect calorie of human milk? An association study between human milk macronutrient and various birth factors.

OBJECTIVE: The purpose of this study is to analyze the macronutrient of human milk (HM) and to find out the various maternal-infantile factors that can affect HM composition. METHODS: 478 HM samples were collected from healthy and exclusively breast-feeding mothers who delivered healthy term neonates within 3 months. Macronutrient of the samples was analyzed and the birth data were collected. RESULTS: In multivariate logistic regression analysis, various maternal-infantile factors were found to be associated with HM composition changes; higher fat: cesarean section (OR = 2.47, p < 0.001) and birth height (OR = 0.84, p = 0.004); higher protein: postpartum age (OR = 0.89, p < 0.001); higher carbohydrate: vaginal delivery (OR = 0.50, p = 0.005) and female infant (OR = 0.56, p = 0.012); higher calorie: postpartum age (OR = 0.95, p = 0.003), female infant (OR = 0.33, p = 0.017), and birth height (OR = 0.74, p < 0.001). Female infant (OR = 0.36, p = 0.029), birth height (OR = 0.73, p = 0.001), and postpartum age (OR = 0.95, p = 0.005) were found as independent risk factors for higher HM calorie. CONCLUSION: Various maternal-infantile factors were found to affect HM composition. Interestingly, delivery mode, gender of infant, and birth height were associated with changes in HM macronutrient as well as postpartum age.

Reference Intervals of Serum Procalcitonin Are Affected by Postnatal Age in Very Low Birth Weight Infants during the First 60 Days after Birth.

BACKGROUND: Procalcitonin (PCT) may be a more sensitive marker for neonatal bacterial infections than C-reactive protein (CRP). However, the reference intervals of serum PCT were not sufficiently studied in neonates older than 1 week of age, especially for very low birth weight infants. OBJECTIVES: This study investigated the reference level of serum PCT for neonates according to gestational age (GA) and postnatal age (PNA). METHODS: Serum PCT was measured in 914 blood samples from 7-60 days after birth in 415 neonates including 184 premature infants. Infants with sepsis, congenital anomaly, or clinically evident intra-amniotic infections were excluded. Multivariate analysis of covariance was used to detect the interaction between GA and PNA. To compare subgroups dichotomized by GA and PNA, analysis of covariance was performed with clinical parameters as covariates to obtain an adjusted p value. RESULTS: Serum PCT levels were negatively correlated with GA, PNA, birth weight, birth height, and platelet count, and positively correlated with white blood cell count, absolute neutrophil count, hematocrit, and serum CRP after logarithmic transformation. Reference intervals of serum PCT were established according to GA and PNA. High PCT levels were found in infants with GA ≤32 weeks and PNA 7-30 days. CONCLUSION: The reference levels of serum PCT were determined according to GA and PNA. As the reference PCT levels of infants with GA ≤32 weeks were affected by PNA, cautious interpretation of PCT levels in these infants is warranted.