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Cord blood procalcitonin level and early-onset sepsis in extremely preterm infants

  • Alice Frerot
  • Olivier Baud
  • Marina Colella
  • Ludmia Taibi
  • Stéphane Bonacorsi
  • Corinne Alberti
  • Damir Mohamed
  • Valérie BiranEmail author
Original Article
  • 73 Downloads

Abstract

Early-onset neonatal sepsis (EOS) is observed in 1.7% of extremely preterm infants, with high morbidity and mortality rate. Cord blood procalcitonin (PCT) is a sensitive marker of EOS in full-term newborns, but it has been rarely studied in premature infants. The diagnostic value of cord blood PCT by immunofluorescence has been assessed as an early marker of EOS in a prospective cohort of extremely preterm infants, with a threshold at 0.5 μg/L. EOS was defined by a positive bacterial culture or by the association of postnatal biological/clinical signs of EOS and antibiotic treatment for more than 72 h. Correlation between PCT serum concentrations and postnatal morbidities was also analyzed. Among a total of 186 infants, 45 (24%) were classified as EOS. Blood PCT concentration was ≤ 0.5 μg/L in 114 infants, including 11 EOS (9.6%) and PCT was > 0.5 μg/L in 72 babies including 34 EOS (47.2%). PCT concentration > 0.5 μg/L was associated with higher risk of EOS (OR 2.18; CI95% 1.58–3.02; p < 0.0001). The receiver operating characteristic curve determined a cutoff of 0.7 μg/L as the best compromise, with an area under the curve of 0.75 (sensitivity 69%, specificity 70%). In multivariate analysis, clinical chorioamnionitis was associated with PCT concentration > 0.5 μg/L (OR 2.58; CI95% 1.35–4.94; p = 0.004). Cord blood PCT is a marker significantly associated with EOS in extremely preterm infants, but its sensitivity remains low. Its added value in combination with other early marker of EOS needs to be further investigated in this high-risk population.

Keywords

Early-onset sepsis Neonatology Procalcitonin Extremely preterm infants Biological marker 

Abbreviations

BPD

Bronchopulmonary dysplasia

CRP

C reactive protein

CI95%

95% Confidence interval

EOS

Early-onset sepsis

IVH

Intra-ventricular hemorrhage

LOS

Late-onset sepsis

NEC

Necrotizing enterocolitis

OR

Odds ratio

PCT

Procalcitonin

ROC

Receiver operating characteristics

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The trial was approved by the Local Ethics Committee (Robert Debré Hospital No. 2017/368-2) and by the French data protection authority, the Commission Nationale de l’Informatique et des Libertés (CNIL).

Informed consent

Written informed consent was obtained from all parents of eligible infants.

References

  1. 1.
    Torchin H, Ancel P-Y, Jarreau P-H, Goffinet F (2015) Epidemiology of preterm birth: prevalence, recent trends, short- and long-term outcomes. J Gynecol Obstet Biol Reprod (Paris) 44(8):723–731CrossRefGoogle Scholar
  2. 2.
    Puopolo KM, Mukhopadhyay S, Hansen NI, Cotten CM, Stoll BJ, Sanchez PJ et al (2017) Identification of extremely premature infants at low risk for early-onset sepsis. Pediatrics 140(5):1–12Google Scholar
  3. 3.
    Shane AL, Sánchez PJ, Stoll BJ (2017) Neonatal sepsis. Lancet 390(10104):1770–1780CrossRefGoogle Scholar
  4. 4.
    Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD (2014) Early-onset neonatal sepsis. Clin Microbiol Rev 27(1):21–47CrossRefGoogle Scholar
  5. 5.
    Cabaret B, Laurans C, Launay E, Orsonneau J-L, Roze J-C, Gras-Le Guen C (2013) Diagnostic value of a new procalcitonin cord sample-guided algorithm to manage newborns suspected of early-onset infection. Arch Pediatr 20(9):954–962CrossRefGoogle Scholar
  6. 6.
    Anaes. Agence Nationale d’Accreditation et d’Evaluation en Sante (2003) Diagnosis and treatment of early bacterial infection in newborns. Arch Pediatr 10(5):489–496CrossRefGoogle Scholar
  7. 7.
    Van Rossum AMC, Wulkan RW, Oudesluys-Murphy AM (2004) Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis 4(10):620–630CrossRefGoogle Scholar
  8. 8.
    Joram N, Muller J-B, Denizot S, Orsonneau J-L, Caillon J, Rozé J-C et al (2011) Umbilical cord blood procalcitonin level in early neonatal infections: a 4-year university hospital cohort study. Eur J Clin Microbiol Infect Dis 30(8):1005–1013CrossRefGoogle Scholar
  9. 9.
    Joram N, Boscher C, Denizot S, Loubersac V, Winer N, Roze JC et al (2006) Umbilical cord blood procalcitonin and C reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection. Arch Dis Child Fetal Neonatal Ed 91(1):F65–F66CrossRefGoogle Scholar
  10. 10.
    Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn JF et al (1998) Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 26(3):664–672CrossRefGoogle Scholar
  11. 11.
    Lencot S, Cabaret B, Sauvage G, Laurans C, Launay E, Orsonneau J-L et al (2014) A new procalcitonin cord-based algorithm in early-onset neonatal infection: for a change of paradigm. Eur J Clin Microbiol Infect Dis 33(7):1229–1238CrossRefGoogle Scholar
  12. 12.
    Murtha AP, Greig PC, Jimmerson CE, Roitman-Johnson B, Allen J, Herbert WN (1996) Maternal serum interleukin-6 concentrations in patients with preterm premature rupture of membranes and evidence of infection. Am J Obstet Gynecol 175(4 Pt 1):966–969CrossRefGoogle Scholar
  13. 13.
    Walsh MC, Yao Q, Gettner P, Hale E, Collins M, Hensman A et al (2004) Impact of a physiologic definition on bronchopulmonary dysplasia rates. Pediatrics 114(5):1305–1311CrossRefGoogle Scholar
  14. 14.
    Papile LA, Burstein J, Burstein R, Koffler H, Koops B (1978) Relationship of intravenous sodium bicarbonate infusions and cerebral intraventricular hemorrhage. J Pediatr 93(5):834–836CrossRefGoogle Scholar
  15. 15.
    Bell MJ (1978) Neonatal necrotizing enterocolitis. N Engl J Med 298(5):281–282Google Scholar
  16. 16.
    Lachassinne E, Letamendia-Richard E, Gaudelus J (2004) Epidemiology of nosocomial infections in neonates. Arch Pediatr 11(3):229–233CrossRefGoogle Scholar
  17. 17.
    Turner D, Hammerman C, Rudensky B, Schlesinger Y, Goia C, Schimmel MS (2006) Procalcitonin in preterm infants during the first few days of life: introducing an age related nomogram. Arch Dis Child Fetal Neonatal Ed 91(4):F283–F286CrossRefGoogle Scholar
  18. 18.
    Goepfert AR, Andrews WW, Carlo W, Ramsey PS, Cliver SP, Goldenberg RL et al (2004) Umbilical cord plasma interleukin-6 concentrations in preterm infants and risk of neonatal morbidity. Am J Obstet Gynecol 191(4):1375–1381CrossRefGoogle Scholar
  19. 19.
    Lautridou A, Ancel P-Y, Launay E, Denizot S, Orsonneau J-L, Roze JC et al (2012) Umbilical cord blood procalcitonin as a risk factor for mortality in very premature infants. Eur J Clin Microbiol Infect Dis 31(9):2407–2412CrossRefGoogle Scholar
  20. 20.
    Sikias P, Parmentier C, Imbert P, Rajguru M, Chavet MS, Coquery S et al (2015) Early-onset neonatal infection: assessment of professional practices in 14 maternity wards in the Île-de-France region in 2013. Arch Pediatr 22(10):1021–1026CrossRefGoogle Scholar
  21. 21.
    Société Française de Néonatologie (SFN) et Haute Autorité de Santé (HAS) (2017) Prise en charge du nouveau-né à risque d’infection néonatale bactérienne précoce(≥ 34 SA). Recommandations pour la pratique clinique. http://www.sfpediatrie.com/sites/default/files/label_has_argumentaire_inbp.09.2017.pdf

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s HospitalUniversity Paris Diderot, Sorbonne Paris-CitéParisFrance
  2. 2.PROTECT, Inserm 1141Université Paris Diderot, Sorbonne Paris CitéParisFrance
  3. 3.PremUP FoundationParisFrance
  4. 4.Division of Neonatology and Pediatric Intensive CareChildren’s University Hospital and University of GenevaGenevaSwitzerland
  5. 5.Biochemistry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s HospitalUniversity Paris Diderot, Sorbonne Paris-CitéParisFrance
  6. 6.Microbiology Department, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’ HospitalUniversity Paris Diderot, Sorbonne Paris-CitéParisFrance
  7. 7.Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s hospital, Inserm U1123 and CIC-EC 1426University Paris Diderot, Sorbonne Paris-CitéParisFrance

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