Procalcitonin in the diagnosis of early-onset neonatal infection in resource-limited settings

Abstract

Objectives: To study the usefulness of procalcitonin (PCT) in comparison to C-reactive protein (CRP) in diagnosis of early onset neonatal infection (EONI) in resource-limited setting. Methods: Admitted newborns to two big neonatal units in Khartoum were investigated for EONI including CBC, urine analysis, blood culture, CRP and PCT. They were given Ampicillin and Gentamycin which were changed as per blood C/S results or according to clinical progress. CRP and PCT were done initially. PCT was repeated 8 h and CRP 36 h later. Decision to continue antibiotics was taken after getting results of 2nd CRP. Three categories were identified: Confirmed EONI were those with positive blood culture, non-infected were asymptomatic with negative blood culture/ other lab support; and the 3rd were those with negative blood culture but non-conclusive clinical/lab results. The 1st and 3rd categories were continued on antibiotics for 7–14 days. PCT levels were compared to CRP levels in the three categories. Results: Fifty-nine newborns were included: mean weight 3.18 kg and mean age 11 hours. Twenty-one infants were confirmed EONI. Isolated organisms were: 9 Staphylococcus epidermidis, 7 Esherishia coli, 3 Klebsiella, one Proteus and one Group B haemolytic streptococcus. Twenty-eight were not infected and ten were nonconclusive. Repeat PCT had better positive and negative predictive values than CRP, at 88.2%, and f 96% respectively. Discussion: Both CRP and PCT were good to guide management of EONI but one test of PCT taken 8 h after initiation of antibiotics treatment might be enough; especially in resource-limited settings.

Keywords

• neonatal infection
• diagnosis
• procalcitonin
• sudan