Association between Chorioamnionitis Severity and Procalcitonin Levels in Umbilical Venous Blood

Abstract

Background: Procalcitonin can effectively differentiate between bacterial sepsis and a systemic inflammatory response syndrome of noninfectious origins in the adult. However, the usefulness of procalcitonin in perinatal field is not determined. Thus, the purpose of this study was to determine whether procalcitonin levels in the umbilical blood reflect the severity of chorioamnionitis and to assess their correlation with perinatal outcomes. Methods: A retrospective study was conducted in 145 pregnant women with singleton pregnancies and their neonates at a tertiary center between September 2010 and March 2013. Procalcitonin levels in the umbilical blood were measured by an immunoluminometric assay. The severity of chorioamnionitis was classified by the histological stage and grade for maternal and fetal inflammatory responses. Procalcitonin levels were evaluated according to the severity of chorioamnionitis; and the association with neonatal sepsis, intraventricular hemorrhage (IVH), neonatal death within 28 days of life, and periventricular leukomalacia was investigated. Results: In total, 28 women (19%) had chorioamnionitis, of which 21 (75%) delivered at less than 34 weeks of gestation. Fetal response in those with chorioamnionitis was correlated with maternal response. Procalcitonin levels in the group with fetal stage 2 and 3 or grade 2 responses were significantly higher than those infants with any other stage or grade. The frequency of neonatal sepsis, IVH stage III or IV, and neonatal death significantly increased (p < 0.01), when a Procalcitonin level of ≥2 ng/mL was obtained. Conclusions: Procalcitonin levels in the umbilical blood reflect the severity of chorioamnionitis and are associated with neonatal outcomes such as neonatal sepsis, neonatal death, and severe IVH. When PCT level in umbilical venous blood show the high value of ≥2 ng/mL, it might be required that antibiotics therapy is initiated immediately after birth.

Keywords

• chorioamnionitis
• intraventricular hemorrhage
• neonatal sepsis
• neonatal death
• procalcitonin
• prematurity
• periventricular leukomalacia