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


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.


Early-onset sepsis Neonatology Procalcitonin Extremely preterm infants Biological marker 



Bronchopulmonary dysplasia


C reactive protein


95% Confidence interval


Early-onset sepsis


Intra-ventricular hemorrhage


Late-onset sepsis


Necrotizing enterocolitis


Odds ratio




Receiver operating characteristics


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.


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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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