Procalcitonin as Predictor of Bacterial Infection in Meconium Aspiration SyndromeFunding INR 25,000 was granted for PCT assay from Institute Intramural Grant for postgraduate thesis work.
08 August 2017
16 November 2017
29 December 2017 (eFirst)
Background There is a lack of definite consensus on indications for initiating antibiotics in neonates with meconium aspiration syndrome (MAS), instigating researchers to search for a biomarker that can help differentiate MAS from MAS with bacterial infection.
Objective Our primary objective was to compare serum procalcitonin (PCT) levels in full-term vigorous neonates having MAS with or without bacterial infection.
Materials and Methods Seventy term vigorous neonates with diagnosis of MAS were enrolled. Blood samples were taken for sepsis screen, C-reactive protein (CRP), PCT, and blood culture at 6 ± 2 hours of respiratory distress. Neonates were categorized into group 1 (MAS without bacterial infection) and group 2 (MAS with bacterial infection) based on blood culture. The duration of our study was 18 months.
Results Mean ± standard deviation PCT level was 2.52 ± 3.99 in group 1 and 2.71 ± 4.22 in group 2, which was comparable. At cutoff of 0.1 ng/mL, PCT had a sensitivity of 90% and specificity of 8% in detecting bacterial infection. Mean total leukocyte count, absolute neutrophil count, immature to total leucocyte ratio, microerythrocyte sedimentation rate, and CRP were comparable.
Conclusion Though PCT is an early and reliable marker of neonatal infection, the levels were increased in neonates with MAS irrespective of the presence of bacterial infection.
P.B. and M.K. conceptualized the study. P.B., M.K., M.M.A.F., and N.P.S. designed the protocol. M.K. collected the data. P.B. and M.K. analyzed and interpreted data, and searched literature. First draft of the article was written by M.K. and further modified by P.B. N.P.S. helped in laboratory analysis. M.M.A.F. and N.P.S. critically analyzed the article. P.B. shall act as guarantor for the study.
- 1 Burris HH. Meconium aspiration. In: Cloherty JP, Eichenwald EC, Hansen AR, Stark AR. , eds. Manual of Neonatal Care, 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2012: 429-434
- 2 Clark P, Duff P. Inhibition of neutrophil oxidative burst and phagocytosis by meconium. Am J Obstet Gynecol 1995; 173 (04) 1301-1305
- 3 Thomas A, Parker KJ. Meconium aspiration syndrome. In: Gleason CA, Devaskar SU. , eds. Avery's Diseases of the Newborn, 9th ed. Philadelphia: Elsevier Saunders; 2012: 652-653
- 4 Adib M, Bakhshiani Z, Navaei F, Saheb Fosoul F, Fouladi S, Kazemzadeh H. Procalcitonin: a reliable marker for the diagnosis of neonatal sepsis. Iran J Basic Med Sci 2012; 15 (02) 777-782
- 5 Zahedpasha Y, Kacho MA, Hajiahmadi MH. Procalcitonin as a marker of neonatal sepsis. Iran J Pediatr 2012; 19 (02) 117-122
- 6 Batra P, Dwivedi AK, Thakur N. Bedside ABG, electrolytes, lactate and procalcitonin in emergency pediatrics. Int J Crit Illn Inj Sci 2014; 4 (03) 247-252
- 7 Eichenwald EC. , ed. NRP Instructor Update. Elk Grove Village, IL: American Academy of Pediatrics, American Heart Association; 2015
- 8 Lembet A, Gaddipati S, Holzman IR, Berkowitz RL, Bottone EJ. Meconium enhances the growth of perinatal bacterial pathogens. Mt Sinai J Med 2003; 70 (02) 126-129
- 9 Goel A, Nangia S, Saili A, Garg A, Sharma S, Randhawa VS. Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)--a randomized controlled trial. Eur J Pediatr 2015; 174 (02) 237-243
- 10 Basu S, Kumar A, Bhatia BD. Role of antibiotics in meconium aspiration syndrome. Ann Trop Paediatr 2007; 27 (02) 107-113
- 11 Lin HC, Su BH, Tsai CH, Lin TW, Yeh TF. Role of antibiotics in management of non-ventilated cases of meconium aspiration syndrome without risk factors for infection. Biol Neonate 2005; 87 (01) 51-55
- 12 Kosim MS, Noerpramana NP, Aminullah A, Hadisaputro S. Antibiotics on incidence of infection with meconium stained amniotic fluid. Paediatr Indones 2013; 53 (01) 50-55
- 13 Zielińska-Borkowska U, Dib N, Tarnowski W. Procalcitonin in diagnosis and monitoring of surgical infections [in Polish]. Pol Merkuriusz Lek 2009; 27 (162) 514-516
- 14 Mohsen AHA, Kamel BA. Predictive values for procalcitonin in the diagnosis of neonatal sepsis. Electron Physician 2015; 7 (04) 1190-1195
- 15 Stocker M, van Herk W, El Helou S. , et al; NeoPInS Study Group. Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomised controlled trial (NeoPIns). Lancet 2017; 390 (10097): 871-881
- 16 Pontrelli G, De Crescenzo F, Buzzetti R. , et al. Accuracy of serum procalcitonin for the diagnosis of sepsis in neonates and children with systemic inflammatory syndrome: a meta-analysis. BMC Infect Dis 2017; 17 (01) 302
- 17 Bonac B, Derganc M, Wraber B, Hojker S. Interleukin-8 and procalcitonin in early diagnosis of early severe bacterial infection in critically ill neonates. Pflugers Arch 2000; 440 (5, Suppl): R72-R74
- 18 Lapillonne A, Basson E, Monneret G, Bienvenu J, Salle BL. Lack of specificity of procalcitonin for sepsis diagnosis in premature infants. Lancet 1998; 351 (9110): 1211-1212
- 19 Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr 1997; 86 (02) 209-212
- 20 Ochi F, Higaki T, Ohta M. , et al. Procalcitonin as a marker of respiratory disorder in neonates. Pediatr Int 2015; 57 (02) 263-268
- 21 Lee J, Bang YH, Lee EH, Choi BM, Hong YS. The influencing factors on procalcitonin values in newborns with noninfectious conditions during the first week of life. Korean J Pediatr 2017; 60 (01) 10-16
- 22 Varsha RU, Rusia U, Sikka M, Faridi MM, Madan N. Validity of hematologic parameters in identification of early and late onset neonatal infection. Indian J Pathol Microbiol 2003; 46 (04) 565-568
- 23 Chacha F, Mirambo MM, Mushi MF. , et al. Utility of qualitative C-reactive protein assay and white blood cells counts in the diagnosis of neonatal septicaemia at Bugando Medical Centre, Tanzania. BMC Pediatr 2014; 14: 248
- 24 Hofer N, Müller W, Resch B. Non-infectious conditions and gestational age influence C-reactive protein values in newborns during the first 3 days of life. Clin Chem Lab Med 2011; 49 (02) 297-302
- 25 Hofer N, Jank K, Strenger V, Pansy J, Resch B. Inflammatory indices in meconium aspiration syndrome. Pediatr Pulmonol 2016; 51 (06) 601-606