| Objective: Neonatal bacterial infection, sepsis in especial, is a major cause of morbidity and mortality in newborn infants. It is vital to identify infected neonates as early as possible, but unreliable clinical signs and the absence of good diagnostic tests hinder an accurate early diagnosis. Thus, sick neonates are frequently treated with broad-spectrum antibiotics. Then antibiotics abuse has contributed to the emergence of multi-resistant bacteria, and even the increase in mortality. The identification of the infected neonate remains one of the most difficult tasks in clinical medicine. C-reactive protein (CRP), one of the acute phase proteins, has been used extensively for its ability to diagnose neonatal bacterial infection. Procalcitonin (PCT) became a new, sensitive marker of neonatal bacterial infections. The aim of our study was to assess and compare the value of PCT and CRP for the early diagnosis of neonatal bacterial infections.Methods: The study was retrospective analysis. One hundred and thirty-two neonatal cases were enrolled. All of them were admitted to neonatal intensive care unit of the Children's Hospital affiliated to Zhejiang University School of Medicineduring 2002~2004, due to suspect bacterial infection with infectious risk factors or infectious symptoms. The neonates were composed of premature (n=55), postmature (n=2), and mature (n=75) according to gestational age; or age group 0-2 days (n=57), age group 3-28 days (n=75) according to age after birth; or neonates with sepsis (n=50), neonates with local bacterial infection (n=31) and neonates without bacterialinfection (n=51) according to final clinical diagnosis. Serum PCT and peripheral blood CRP levels on admission were checked and recorded. Neonates whose PCT concentration was >0.5ng/ml or CRP concentration was >8mg/L were counted as positive. According to aims of our study, neonates were divided into different groups and then the value (sensitivity and specificity) of PCT and CRP for the early diagnosis of neonatal bacterial infections was assessed.Results: PCT concentration was >0.5ng/ml in 43 of 81 neonates with bacterial infections (sensitivity 52.4%), in 29 of 51 neonates without bacterial infections (specificity 33.3%), CRP concentration was >8mg/L in 31 of 81 neonates with bacterial infections (sensitivity 33.3%) and in 3 of 51 neonates without bacterial infections (specificity 91.7%), PCT offers better sensitivity than CRP, but its specificity is not better (p<0.01). PCT offers better sensibility than CRP to differentiate between sepsis and local bacterial infection (62%, 50% respectively,p all <0 05). With respect to the sensitivity for the diagnosis of culture-proven sepsis, there was no significant difference between PCT (54.5%) and CRP (36.4%) (p>0.05), and the sensitivity for the diagnosis of clinical sepsis between PCT (64.1%) and CRP (53.8%) was not significantly different either (p>0.05). The sensibility of PCT between premature (53.3%) and mature (56%) was not statistically different (p>0.05), and same result was found in the sensibility of CRP (30%, 42% respectively, />>0.05). With regard to the specificity of PCT, there was no significant difference between premature (52%) and mature (44%) (p>0.05), and the specificity of CRP was not significant difference either (100%, 88% respectively, p>0.05). The sensibility of PCT between age group 0-2 days (52.4%) and 3-28 days (53.3%) was not statistically different (p>0.05), and the sensibility of CRP was not different either (33.3%, 43.3% respectively, p>0.05). Concerning the specificity of PCT, there was significant difference between age group 0-2 days (33.3%) and 3-28 days (66.7%) (p<0.05). PCT offers better specificity of age group 3-28 days than 0-2 days, but the specificity of CRP was not statistically different, 91.7%, 100% respectively (p>0.05).Conclusion: PCT offers better sensitivity than CRP for the early diagnosis ofneonatal bacterial infections, but its specificity is not better. PCT offers better sensibility t...
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