Faculdade de Ciências Médicas/NOVA Medical School/UNL. CHLC, Dona Estefânia Hospital Lisbon. Portugal.
- Palestra. 8th International Congress UENPS. Bucareste 3–5 Outubro 2018
Diagnosis of neonatal sepsis continues to be a difficult task. Signs of infection lack specificity. While waiting for blood culture the clinician needs to support the decision to prescribe antibiotics. There has been a fast evolution for bacterial identification but not on biomarkers of sepsis. After thousands of studies we may conclude: for the last two decades we have been studying the same markers; results of studies on the same marker may be not comparable; each author rarely conclude that a specific marker studied by him is not reliable; by now older markers have not been replaced by new ones. It is possible the grade of inflammatory response be influenced by the causative microorganism. In our studies we found the highest levels for C-RP, IL6, TNFα and PCT were found in babies with septicaemia caused by GBS, Kl pn,E.cloacae and the lowest in babies with CoNS. Vouloumanou found similar results. C-RP is the most extensively studied and used acute phase reactant with unique features: performed in all laboratories, technically simple, rapid response, well-known cut-off values. Serial determinations in combination with I/T neutrophils have high negative predictive value of sepsis 24 to 48h after the onset of symptoms allowing to stop antibiotics by 48 hours. About procalcitonin David Isaacs is clear: “Routine measurement is not recommended in suspected sepsis. However for an infant with possible sepsis, an abnormal result is strong for starting antibiotics”. IL6 is the most studied cytokine. IL6 may be positive even before the clinical suspicion of sepsis and before the rise of CRP but the very short half-life - already negative when other markers are still climbing - prevents its use. Other markers will be addressed in this talk just to conclude that the only one useful in the clinical practice is C-RP.
Keywords: Biomarkers, Neonatal infection, Sensitivity, Specificity