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Background and Objective: Serum procalcitonin (PCT) monitoring may help clinicians to manage nosocomial infections in neonates. This study investigated the diagnostic value of a new, rapid method to measure PCT and sought to determine the best cut-off value., Methods: This monocentric, prospective study included all newborn infants with clinical suspicion of infection in a neonatal intensive care unit. Rapid, automated PCT measurements were performed on blood samples obtained for C-reactive protein (CRP) measurement. Negative and positive predictive values, sensitivity and specificity were calculated. Logistic regression analysis determined the best cut-off value to obtain a negative predictive value of PCT that was at least 15% above that of CRP., Results: Between June 2005 and May 2006, 73 newborn infants with a median (Q25-Q75) gestational age of 28 (26-30) weeks and a birth weight of 995 (720-1350) g were included. Thirty (41%) were infected. The best PCT cut-off value was 0.6 ng/ml, which provided a negative predictive value of 100%. The sensitivity, specificity and positive predictive value were 100%, 65%, and 67%, respectively, for PCT at the 0.6 ng/ml cut-off value., Conclusion: Rapid measurement of PCT could help to rule out nosocomial infection in newborn infants hospitalised in intensive care units.

In order to assess the potential fo procalcitonin measurement in the management of neonatal sepsis, daily variations in serum procalcitonin (measured by an immunoluminometric assay) were evaluated in 94 control and infected newborn infants in comparison to C-reactive protein (measured by an immunonephelometric method). High levels of procalcitonin correlated with bacterial invasion and showed no discrepancies with C-reactive protein. procalcitonin increased (up to 400 micrograms l-1 and returned to the normal range (< 0.1 microgram l-1) more quickly than C-reactive protein, suggesting that procalcitonin may be an early marker of favourable outcome. Another finding is a significant procalcitonin peak on the first day of life in the control group, independent of any infectious stimulus. In conclusion, procalcitonin seems to be an interesting marker of neonatal sepsis but additional investigations are needed to understand better its mechanism of synthesis in order to determine its clinical usefulness.