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New criterion may detect bacterial infection sooner in preterm infants
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Recent findings presented in Scientific Reports showed that an age-specific, percentile-based reference curve of serum procalcitonin concentrations could detect late-onset bacterial infection and sepsis in preterm infants.
“We established a postnatal age-specific percentile-based reference of serum [procalcitonin (PCT)] in newborn infants, and showed that physiological changes in late preterm infants were significantly different from those in preterm infants, but not in term infants,” Ichiro Morioka, MD, PhD, in the department of pediatrics at Kobe University Graduate School of Medicine, and colleagues wrote. “Furthermore, we established a postnatal age-specific, percentile-based reference in preterm infants, and determined that the serum PCT concentration reaches adult, normal levels (0.1 ng/mL) after 9 weeks old.”
Ichiro Morioka
PCT is known to be a more sensitive marker than white blood cell count and C-reactive protein level in the early identification of bacterial infection and sepsis in adults and children, because PCT is released into the blood several hours after infection begins, the researchers wrote. While the reference range of serum PCT levels is known for adults and children, these levels in newborns should be assessed using distinguished references for each infant population.
From June to December 2014, Japanese researchers examined 1,267 serums from 283 newborns at the Kobe University Hospital neonatal ICU.
The researchers found that the PCT concentrations peaked at age 1 day and decreased thereafter. At age 1 day, PCT concentrations in infants younger than 34 weeks’ gestation (preterm) were greater than in those in infants of 34 to 36 weeks’ gestation (late preterm) and those older than at least 37 weeks’ gestation (term). The 50th percentile value in late preterm and term infants attained the adult normal level (0.1 ng/mL) at 5 days old, while it took 9 weeks in preterm infants. Serum PCT concentrations at onset in late-onset infected preterm infants exceeded the 95th percentile value, the investigators wrote.
Along with improving the prognosis of bacterial infections in preterm infants, the researchers’ method has other benefits.
“We could also potentially use this method to limit unnecessary use of antibacterial agents,” Morioka said in a press release. “Our next step is to verify the precision of diagnoses based on these reference curves.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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