The Role of Procalcitonin in Neonatal Sepsis-examining Facts and Misconceptions

Neonatal sepsis has remained a major cause of neonatal morbidity and mortality. Despite advances in neonatal diagnostics, its diagnosis has remained challenging majorly because its symptoms are vague and blood culture which remains the gold standard for diagnosis is cumbersome and has poor yield and other forms of sepsis are usually not sought for (anaerobes, viral fungal). The search for newer diagnostic methods is still on going and procalcitonin has shown some promise. The aim of the study is to examine the role procalcitonin plays in neonatal sepsis. A total of 248 neonates with suspicion of sepsis were enrolled and had their samples taken for blood culture, full blood count, C-reactive and procalcitonin assay based on which the neonates were classified as proven, suspected and clinical sepsis. The behaviour of procalcitonin in the different sepsis groups (more elevated in proven and suspected than clinical), ages (to accommodate the physiologic variation seen in the first 72hours of life) and according to isolates (more elevated in gram negative than gram positive sepsis). The diagnostic value of procalcitonin was also determined and found have sensitivity 74.5%, specificity 38.3%, positive predictive value 42.4% and negative predictive value 71.1%, which were better after >72hours of life. For now, procalcitonin should continue to serve as a supportive marker for sepsis as its levels are affected by age of the neonate, sepsis mimics, and type of offending organism causing the infection.