Objectives: To compare between the expenses and benefits of procalcitonin testing in the diagnosis of early onset neonatal sepsis in Egyptian Governmental Hospitals.
Methods: Admitted newborns were investigated for neonatal sepsis including CBC, blood culture, CRP, and PCT. They were given Ampicillin and Gentamicin which were changed as per blood C/S results or according to clinical progress. CRP and PCT were done initially. PCT was repeated 8h and CRP 24h later. Three categories were identified: proven sepsis with positive blood culture, not-proven sepsis with negative
blood culture, and suspected sepsis with no clinical or laboratory evidence of infection .PCT levels were compared to CRP levels in all categories.
Results: eighty-nine newborns with neonatal sepsis were included, mean weight was± 3.150 kg. Mean age at presentation was ±14 hours. clinical features of the newborns on admission to NICU were presented in table (1).Twenty- nine infants were proven neonatal sepsis. Isolated organisms were: 9 Klebsiela, 7 Ecoli, 6 Group B streptococci, 4 Pseudomonas, and 3 MRSA. Thirty- six with not-proven sepsis, while twenty-four had suspected sepsis. Table (2) shows CRP1/PCT1 results in the group with proven sepsis and those infected but not proven in Table (3). CRP2/PCT2 for the two categories are shown in Table 4 and 5. Comparing the predictive values of PCT2 and CRP2, PCT2 has higher sensitivity and specificity than CRP2.Repeat PCT had better ability to distinguish infected from non-infected patients.
Discussion: both CRP and PCT were good to guide management of neonatal sepsis, but repeat PCT after 8 h after initiation of antibiotics treatment might be enough to detect precisely cases with early onset sepsis, with no need to wait for results of blood culture, especially in countries with limited resources.
Conclusion: The expense of testing PCT twice is less than the expenses of one-day admission in NICU in developing countries. Application of such protocol could be of use in limiting period of stay in NICU.
