Umbilical Cord Procalcitonin to Detect Early-Onset Sepsis in Newborns: A Promising Biomarker

Background: Up to 7% of neonates born in high-income countries receive antibiotics for suspected early-onset sepsis (EOS). Culture-proven neonatal sepsis has a prevalence of 0.2%, suggesting considerable overtreatment. We studied the diagnostic accuracy of umbilical cord blood and infant blood procalcitonin (PCT) in diagnosing EOS to improve antibiotic stewardship.Methods: Umbilical cord blood PCT was tested in newborns ≥ 32 weeks of gestation. Groups were defined as following: A) culture-proven or probable EOS (n = 25); B) Possible EOS, based on risk factors for which antibiotics were administered for <72 h (n = 49); C) Risk factor(s) for EOS without need for antibiotic treatment (n = 181); D) Healthy controls (n = 74). Additionally, venous or capillary blood PCT and C-reactive protein (CRP) were tested if blood drawing was necessary for standard care.Results: Between June 2019 and March 2021, 329 newborns were included. Umbilical cord blood PCT was significantly higher in group A than in group C and D. No difference between venous or arterial samples was found. Sensitivity and specificity for cord blood procalcitonin were 83 and 62%, respectively (cut-off 0.1 ng/mL). Antepartum maternal antibiotic administration was associated with decreased PCT levels in both cord blood and infant blood directly postpartum in all groups combined.Conclusion: Umbilical cord blood PCT levels are increased in newborns ≥32 weeks with a proven or probable EOS and low in newborns with risk factors for infection, but PCT seems not a reliable marker after maternal antibiotic treatment. PCT could be useful to distinguish infected from healthy newborns with or without EOS risk factors.

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Study of umbilical cord blood culture in diagnosis of early-onset sepsis among newborns with high-risk factors

Journal of Clinical Neonatology ◽

10.4103/2249-4847.123092 ◽

2013 ◽

Vol 2 (4) ◽

pp. 169 ◽

Cited By ~ 6

Author(s):

MitulBabubhai Kalathia ◽

IlaMitulkumar Kalathia ◽

PrakashAshokbhai Shingala ◽

ParinNiranjanbhai Parmar ◽

YogeshNarenedrabhai Parikh

Keyword(s):

Risk Factors ◽

High Risk ◽

Blood Culture ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Early Onset ◽

High Risk Factors ◽

Early Onset Sepsis

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Umbilical cord blood procalcitonin and C reactive protein concentrations as markers for early diagnosis of very early onset neonatal infection

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/adc.2005.074245 ◽

2005 ◽

Vol 91 (1) ◽

pp. F65-F66 ◽

Cited By ~ 48

Author(s):

N Joram

Keyword(s):

Early Diagnosis ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Early Onset ◽

Neonatal Infection ◽

C Reactive Protein ◽

Reactive Protein

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Eliminating Contamination in Umbilical Cord Blood Culture Sampling for Early-Onset Neonatal Sepsis

Frontiers in Pediatrics ◽

10.3389/fped.2021.794710 ◽

2021 ◽

Vol 9 ◽

Author(s):

Vilmaris Quinones Cardona ◽

Vanessa Lowery ◽

David Cooperberg ◽

Endla K. Anday ◽

Alison J. Carey

Keyword(s):

Quality Improvement ◽

Blood Culture ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Peripheral Blood ◽

Early Onset ◽

Clinical Sepsis ◽

Early Onset Sepsis ◽

Antibiotic Duration

Introduction: Despite the advantages of umbilical cord blood culture (UCBC) use for diagnosis of early onset sepsis (EOS), contamination rates have deterred neonatologists from its widespread use. We aimed to implement UCBC collection in a level III neonatal intensive care unit (NICU) and apply quality improvement (QI) methods to reduce contamination in the diagnosis of early onset sepsis.Methods: Single-center implementation study utilizing quality improvement methodology to achieve 0% contamination rate in UCBC samples using the Plan-Do-Study-Act (PDSA) model for improvement. UCBC was obtained in conjunction with peripheral blood cultures (PBC) in neonates admitted to the NICU due to maternal chorioamnionitis. Maternal and neonatal characteristics between clinical sepsis and asymptomatic groups were compared. Process, outcome, and balancing measures were monitored.Results: Eighty-two UCBC samples were collected in addition to peripheral blood culture from neonates admitted due to maternal chorioamnionitis. Ten (12%) neonates had a diagnosis of clinical sepsis. All PBCs were negative and 5 UCBCs were positive in the study period. After 2 PDSA cycles, there was special cause variation with improvement in the percent of contaminated samples from 7.3 to 0%. There was no change in antibiotic duration among asymptomatic neonates.Conclusions: Implementation of UCBC for the diagnosis of EOS in term infants is feasible and contamination can be minimized with the implementation of a core team of trained providers and a proper sterile technique without increasing antibiotic duration.

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Assessment of oxidative damage and enzymatic antioxidant system activity on the umbilical cord blood and saliva from preterm newborns with risk factors for early-onset neonatal sepsis

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.10.888 ◽

2018 ◽

Vol 64 (10) ◽

pp. 888-895 ◽

Cited By ~ 1

Author(s):

Fábio Gonçalves Coutinho ◽

Edna Maria de Albuquerque Diniz ◽

Ingrid Kandler ◽

Marco Antônio Cianciarullo ◽

Natália Rodrigues dos Santos

Keyword(s):

Risk Factors ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Neonatal Sepsis ◽

Early Onset ◽

Umbilical Vein ◽

Statistical Significance ◽

Cross Sectional ◽

Significant Difference

SUMMARY BACKGROUND: To determine the concentration of the Lipid Peroxidation Marker: Malondialdehyde (MDA), and Antioxidant Markers: Superoxide Dismutase (SOD), Glutathione Peroxidase (GPX), Catalase (CAL) in umbilical cord blood and in unstimulated saliva in the first 24 and 48 hours of life in the PTNB of mothers with and without risk factors for early-onset neonatal sepsis. METHODS: Cross-sectional study with the signing of informed consent by the pregnant women and application of a standard questionnaire classifying the PTNB in Group 1 or 2. RESULTS: Twenty-one PTNB were studied. Regarding gender, birth weight, need for oxygen, use of phototherapy, diagnosis of assumed sepsis, presence of fetal distress, number of pregnancies, type of delivery, use of corticosteroids, premature rupture of membranes, maternal fever, chorioamnionitis, APGAR at the 5th and 10th minute of life. Statistical analysis was performed with the Mann-Whitney test (p = 0.019) on the GPX variable of umbilical cord blood in the group of mothers with risk factors for early-onset neonatal sepsis. There was no statistical difference in the MDA, SOD, and CAT variables of the group with risk factors and in any variable of the group without risk factors. CONCLUSION: There was an increase of the GPX concentration in the blood from the umbilical vein in the group with risk factors for early-onset neonatal sepsis. There was no statistical significance in the comparison of saliva and umbilical cord blood. There was no statistically significant difference in MDA, SOD, CAT.

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The Correlation of Antibacterial Peptides Concentration in Umbilical Cord Blood and Early-Onset Sepsis in Preterm Infants

10.21203/rs.3.rs-233772/v1 ◽

2021 ◽

Author(s):

Jiayu Miao ◽

Ying Liu ◽

Zengqing Li ◽

Zhuxiao Ren ◽

Zhicheng Zhong ◽

...

Keyword(s):

Cord Blood ◽

Preterm Infants ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Early Onset ◽

Sepsis Group ◽

Control Group ◽

Early Onset Sepsis ◽

Prediction Probability

Abstract Background: The role of serum LL37 in systemic inflammation has been confirmed, and the influence of it in umbilical cord blood to early-onset sepsis in preterm infants is currently being investigated.Results: The level of LL37 of sepsis group was higher than those of in control group (362.13±46.71 vs 248.13±83.30 ng/ml), the levels of CRP, WBC and MPV in sepsis group were higher than those of in control group (6.25±4.19 vs 2.89±2.77 mg/L; 17.60±12.35 vs 8.24±3.55×109/L; 11.10±1.11 vs 8.93±0.68 fL), the level of PLT was lower than those of in control group (175.20±38.51 vs 245.75±49.85×109/L) (P < 0.05). The expression of LL37 was negatively correlated with PLT (r = -0.9347, P < 0.0001), and positively correlated with MPV ((r =0.9463 , P < 0.0001), the expression of PLT was negatively correlated with MPV (r = -0.9641, P < 0.0001). The area under curve of LL37 for diagnosis of early-onset sepsis was 0.875, the prediction probability was 0.7, the sensitivity was 90.0% and the specificity was 80.0%.Conclusions：The higher level of LL37 in umbilical cord blood was associated with the development of early-onset sepsis in preterm infants.

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