Neonatal Sepsis-Early detection comparing Procalcitonin and CRP as Markers and Newer Tools

Background:Neonatal sepsis continues to be a major cause of morbidity and mortality in India, but is treatable if diagnosis is made in time.

Objectives: The present study was undertaken to evaluate and highlight the importance of procalcitonin v\s CRP in early detection of neonatal sepsis.

Materials and Methods: The prospective study enrolled 150 neonates who had maternal risk factors and clinically suspected of infection (study group). Abnormal total leukocyte count, abnormal total polymorphonuclear neutrophils (PMN) count, elevated immature PMN count, elevated immature: Total (I:T) PMN ratio, platelet count ≤150,000/mm3, and pronounced degenerative or toxic changes in PMN were noted by the pathologist who were blind for the clinical status of the baby in NICU. Blood culture was taken as a gold standard for septicemia. The perinatal history, clinical profile and laboratory data were recorded and correlated in each case. Each hematological parameter was assessed for its individual performance and also with the culture-proven sepsis. Sensitivity, specificity, positive and negative predictive values (NPVs) were calculated for each parameter and for different gestational ages. P value was also calculated for different parameters.

Results: Among 150 babies evaluated for sepsis in NICU over a period of one year, Procalcitonin is observed as better early marker of neonatal sepsis over and CRP:- Procalcitonin in comparison with CRP: - Sensitivity was 97% Specificity was 59% PPV was 70% and NPV was 99.9%. With area under ROC curve being 0.915(p-value of 0.02) CRP in comparison with Procalcitonin: - Sensitivity was 75% Specificity was 75% PPV was 86% and NPV was 99%. With area under ROC curve being 0.769 (p- value 0.61).

Conclusion: The sensitivities of the screening test namely C-reactive protein and Procalcitonin were found to be satisfactory in identifying neonatal sepsis. Comparing to Other test procalcitonin appears to be simple and feasible diagnostic tool although costly.