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Letters |
1
Immunology Laboratory, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France
2
Department of Neonatology, Hôpital Debrousse, 69322 Lyon Cedex 05, France
3
Laboratory of Clinical Chemistry, Hôpital Debrousse, 69322 Lyon Cedex 05, France
a Author for correspondence. Fax 33 4 78 86 33 44; e-mail bienvenu{at}univ-lyon1.fr
To the Editor:
We are very interested in the report by Sachse et al. (1) on procalcitonin (PCT) variations in the neonatal period. This report confirms and extends previous work on the daily variations of PCT during the first days of life in noninfected newborn infants (2)(3). We agree that PCT could be a useful marker for the presence, course, and prognosis of bacterial infection, particularly in newborns hospitalized with a risk factor for infection (such as an increase in the mother's body temperature during delivery, premature rupture of membranes, vaginal colonization by group B streptococcus, and other factors). In this context, prophylactic antibiotic therapy is started during labor and if clinical signs of infection are present at delivery, antibiotics are continued. Thus, the diagnosis of infection cannot be confirmed by culture because this preventive therapy is responsible for the negativity of bacteriological tests (blood and cerebrospinal fluid cultures).
We present additional data on PCT values obtained in 52 neonates hospitalized with a risk factor for infection. All mothers received a prophylactic antibiotic (Ampicillin®), and all samples were negative by bacteriological tests. Two groups were defined on the basis of health status. The first group (n = 44) comprised newborn infants with a risk factor for infection without clinical signs of infection. The second group (n = 8) comprised newborn infants with a risk factor for infection and clinical signs of infection at birth (bradycardia, apnea, hypotension, microcirculation impairment, changes of skin coloration, or an increase of the neonate's body temperature).
The blood samples were obtained at 24 and 72 h of life. PCT was
determined using an immunoluminometric assay (Brahms
Diagnostica). The PCT concentrations (3.5 ± 0.5 µg/L) in
the group of newborn infants without clinical signs of infection (Table 1
) were similar to those published elsewhere (1)(2)(3).
In contrast, in the second group a significant increase of PCT was
observed on the first day of life (58.2 ± 7.1 µg/L).
Nevertheless, these values were lower than our previous values
described in materno-fetal infection, e.g., 162 ± 32 µg/L
(2), but higher than the physiological peak reported by
Sachse et al. (1) and by our group (2). In the
second group, PCT concentrations decreased on the third day of life.
Thus, increased PCT represents a biological marker of materno-fetal
infection, the negativity of bacteriological samples being a reflection
of the efficacy of the early antibiotic prophylaxis.
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In conclusion, even with the existence of a physiological peak, PCT is useful in the diagnosis and monitoring of neonates at risk of infection, particularly when the bacteriological samples are negative. Additional data are needed to document the value of PCT measurements for reducing the need for invasive collection of samples for bacteriological testing and for reducing the use/abuse of antibiotics.
References
The following articles in journals at HighWire Press have cited this article:
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  M. Assumma, F. Signore, L. Pacifico, N. Rossi, J. F. Osborn, and C. Chiesa Serum Procalcitonin Concentrations in Term Delivering Mothers and Their Healthy Offspring: A Longitudinal Study Clin. Chem., October 1, 2000; 46(10): 1583 - 1587. [Abstract] [Full Text] [PDF]
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