Valor predictivo de la procalcitonina para sepsis neonatal temprana en recién nacidos prematuros con antecedente de ruptura prematura de membranas y/o corioamionitis

Abstract

Introduction: Early neonatal sepsis is a major diseases threatening the lives of newborns worldwide die 5 million newborns a year and of these, 98% occurs in developing countries, with a neonatal sepsis rate between 20-40% associated with premature rupture of membranes (PROM) up to 33%. A newborn with fever is a common medical problem, can be a challenge for the clinician to differentiate between those who have a serious bacterial infection and those with a localized bacterial infection or a viral infection. Objective: To determine the predictive value of procalcitonin for early neonatal sepsis in premature neonates with risk factors. Material and methods: We performed a cohort study. Inclusion criteria were: 1) newborn preterm <37 weeks gestation and was born at the National Institute of Perinatology during the study period, 2) A history of premature rupture of membranes or maternal chorioamnionitis. 3) Letter of informed consent. The diagnosis of sepsis was performed using the following criteria: Two or more clinical data with two or more blood disorders, was confirmed by positive blood culture. We obtained a 0.5 mL blood sample at different times (0, 12, 24, 48 and 72 h) and procalcitonin was determined by quantitative analysis inmunoluminimétrico. Was a Friedman analysis of variance to compare procalcitonin concentrations at different times in each patient., X2 for nominal variables, and determined the positive predictive value, negative, sensitivity and specificity of the biomarker. Results: We studied 126 preterm infants, 62 of them developed sepsis and 64 no, sex ratio was 61 women and 65 men with mean gestational age of 33.3 ± 3.42 SDG) and 1.873 ± weight of 700.27 g) with a total number of 516 samples taken at 5 different times, being significant those taken at 0, 12 and 24 h, with a sensitivity and specificity, PPV and NPV of the test. Procalcitonin measurements at birth had half of 5.2 ± 9.2 to 2.8 ± 6.1 ng / mL in the group with sepsis, at 12 h, reported an average of 9.74 against 4.39 ± 15.1 ± 9.3 at 24 h, the average was 7.65 ± 11.9 to 3.7 ± 7.7, at 48 h of 6.43 ± 9.2 3.56 ± 6.56 against, and 72 h of 6.40 ± 7.5 4.86 ± 5.83 against ng / mL. The history of chorioamnionitis occurred in 25 infants who developed sepsis and premature rupture of membranes in 27 newborns.