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

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

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.

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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

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France

    Alice Frerot, Olivier Baud, Marina Colella & Valérie Biran

  2. PROTECT, Inserm 1141, Université Paris Diderot, Sorbonne Paris Cité, 75019, Paris, France

    Alice Frerot, Olivier Baud, Marina Colella & Valérie Biran

  3. PremUP Foundation, 75014, Paris, France

    Alice Frerot, Olivier Baud, Marina Colella & Valérie Biran

  4. Division of Neonatology and Pediatric Intensive Care, Children’s University Hospital and University of Geneva, Geneva, Switzerland

    Olivier Baud

  5. Biochemistry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France

    Ludmia Taibi

  6. Microbiology Department, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’ Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France

    Stéphane Bonacorsi

  7. Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children’s hospital, Inserm U1123 and CIC-EC 1426, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France

    Corinne Alberti & Damir Mohamed

Authors
  1. Alice Frerot
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  2. Olivier Baud
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  3. Marina Colella
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  4. Ludmia Taibi
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  7. Damir Mohamed
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  8. Valérie Biran
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Corresponding author

Correspondence to Valérie Biran.

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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).

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

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Frerot, A., Baud, O., Colella, M. et al. Cord blood procalcitonin level and early-onset sepsis in extremely preterm infants. Eur J Clin Microbiol Infect Dis 38, 1651–1657 (2019). https://doi.org/10.1007/s10096-019-03593-0

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  • DOI: https://doi.org/10.1007/s10096-019-03593-0

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