Value of Serum Pro-adrenomedullin in Diagnosis of Neonatal Sepsis

Abstract

Introduction : Neonatal sepsis is a life-threatening condition that represents one of the major causes of morbidity and mortality among term and preterm infants. Pro-adrenomedullin (Pro-ADM) is the precursor of adrenomedullin, one of the inflammatory mediators. It is a more stable molecule, and its level has been reported to correlate with other acute phase reactants, such as interleukin-6 and C-reactive protein (CRP). Aim of the study: The study aimed to evaluate the value of serum pro-adrenomedullin measurement in the diagnosis of neonatal sepsis. Subjects and Methods: This cross-sectional study enrolled 50 neonates admitted to the neonatal ICU at Beni-suef General Hospital in 2017 and 2018 with clinical and laboratory evidence of sepsis. Normal healthy neonates (N = 30) were recruited as the control. All participants were subjected to history taking, clinical examination, and routine lab investigations, as well as, blood culture and measurement of serum Pro-ADM (using enzyme-linked immunosorbent assay). Results: The mean serum levels of both CRP and pro-ADM were significantly higher in the sepsis group compared to the healthy control neonates. Their diagnostic performances were found to be good with an overall accuracy of 80.4% and 91.3%, respectively. CRP and pro-ADM had comparable values for sensitivity (78% and 98%), specificity (84.4% and 81.2%), positive predictive value (88.6% and 88.9%), negative predictive value (71.1% and 96.3%), respectively. Conclusion: Pro-ADM seems to be a good, reliable diagnostic marker in neonatal sepsis. Pro-ADM levels above 20.1 indicate a high probability of sepsis diagnosis, and it may be a better marker of neonatal sepsis than CRP because it exceeded the performance of the latter.