Rajeev D1 , Sujatha R2

BACKGROUND: Neonatal sepsis is difficult to diagnose because it is associated with nonspecific signs and symptoms and a high index of suspicion is required for early diagnosis. Several acute phase reactants help to indicate the presence of infection in a neonate, of which Procalcitonin (PCT) and C-reactive protein (CRP) are important. OBJECTIVES: The current study was conducted to assess PCT levels and the suitability of this assessment in diagnosis of early onset sepsis, and to compare PCT with CRP levels. METHODS: The blood samples from 100 neonates whose mothers had any one of the risk factors including premature rupture of membranes (PROM) > 12 hours, more than 3 vaginal examinations after rupture of membranes, intrapartum fever, foul smelling liquor, meconium stained liquor, maternal UTI within 2 weeks prior to delivery and prolonged and difficult delivery with instrumentation, were collected. Blood culture and sensitivity, PCT and CRP levels, total count, absolute neutrophil count and band width were done. RESULTS: A total of 100 neonates were included in this study. Of the risk factors, meconium stained liquor was the most common, present in 60% of the cases. Of the 100 neonates, procalcitonin was positive in 34 (34%; 90% CI 26.7-42.1), CRP in 22 (22%; 90% CI 15.9-29.5) and blood culture in 9 (9%; CI 5.3-14.9). Of all the maternal risk factors, a statistically significant association was observed only in case of foul smelling liquor for both procalcitonin as well as CRP positivity. Procalcitonin when compared with CRP had a sensitivity of 100%, specificity of 84.6%, positive predictive value (PPV) of 64.7% and negative predictive value of 100%. CONCLUSION: Assessing PCT and CRP levels are relatively accurate and rapid diagnostic methods in diagnosing neonatal sepsis and also help in guiding antibiotic therapy. Although testing for PCT is expensive, it seems to be a better marker than CRP, especially in diagnosing early onset sepsis.