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C-Reactive Protein, Interleukin-6, and Procalcitonin in the Immediate Postnatal Period: Influence of Illness Severity, Risk Status, Antenatal and Perinatal Complications, and Infection

¹ National Research Council, 00161 Rome, Italy.
Institutes of
² Pediatrics and
⁴ Hygiene, "La Sapienza" University of Rome, 00161 Rome, Italy.
Divisions of
³ Neonatology and
⁵ Obstetrics, S. Camillo Hospital, 00152 Rome, Italy.

^aAddress correspondence to this author at: Institute of Pediatrics, "La Sapienza" University of Rome, Viale R. Elena, 324 00161 Rome, Italy. Fax 39-06-4997-9216; e-mail Claudio.Chiesa{at}Uniroma1.it.

Background: Studies of the diagnostic accuracy of most laboratory tests for early-onset neonatal sepsis have yielded variable results. We investigated whether some of this variation might be attributable to differences in population baseline severity and risk status as well as to specific ante- and perinatal variables, independent of the presence of neonatal infection.

Methods: The Score for Neonatal Acute Physiology (SNAP) was used to define illness severity, with SNAP Perinatal Extension (SNAP-PE) used to define the combined physiologic and perinatal mortality risk. A total of 134 ill newborns (19 with early-onset infection and 115 with no infection) were available for simultaneous analysis of the association of SNAP, SNAP-PE, and maternal and perinatal variables with C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) concentrations at birth and at 24 and 48 h of life.

Results: Early-onset neonatal infection was associated with significant increases in CRP, IL-6, and PCT concentrations at all three time points, independent of illness severity. However, among babies without infection, higher SNAP and SNAP-PE scores were associated with higher IL-6 concentrations at birth. Certain maternal or perinatal variables altered IL-6 and PCT values in the infected as well as in the uninfected neonates. However, if different cutoff points were used at any of the three neonatal ages, PCT sensitivity and specificity were greater than those of CRP or IL-6.

Conclusions: Illness severity and risk status are unlikely to interfere with the use of CRP and PCT for detection of early-onset neonatal sepsis. In contrast, the diagnostic value of IL-6 at birth may be altered by physiologic severity and risk indexes. The reliability of CRP, IL-6, and PCT for the diagnosis of early-onset neonatal infection requires specific cutoff values for each evaluation time point over the first 48 h of life.

The following articles in journals at HighWire Press have cited this article:

				U K Mishra, S E Jacobs, L W Doyle, and S M Garland Newer approaches to the diagnosis of early onset neonatal sepsis. Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2006; 91(3): F208 - F212. [Abstract] [Full Text] [PDF]

				S. D. Carrigan, G. Scott, and M. Tabrizian Toward Resolving the Challenges of Sepsis Diagnosis Clin. Chem., August 1, 2004; 50(8): 1301 - 1314. [Abstract] [Full Text] [PDF]

				C. Chiesa, A. Panero, J. F. Osborn, A. F. Simonetti, and L. Pacifico Diagnosis of Neonatal Sepsis: A Clinical and Laboratory Challenge Clin. Chem., February 1, 2004; 50(2): 279 - 287. [Full Text] [PDF]