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Serum Biomarkers for the Early Detection of the Early-Onset Neonatal Sepsis

A Single-Center Prospective Study

Ahmed, Ali Mahmoud MBBCh; Mohammed, Abdelrahman Tarek MBBCh; Bastawy, Samah MD; Attalla, Hams Ahmed MD; Yousef, Aly Abdelrahman MD; Abdelrazek, MennatAllah Sayed MBBCh; Fransawy Alkomos, Mina MBBCh; Ghareeb, Ahmed MBBCh

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000631
Original Research

Background: Reducing the hazards of the early-onset neonatal sepsis (EONS) is a priority justifying the further investigation for potential biomarkers for its early diagnosis.

Purpose: We aimed to investigate the diagnostic value of presepsin, procalcitonin, lactoferrin, interleukin (IL)-6, and IL-8 for the early diagnosis of EONS.

Methods: A prospective comparative study, including 30 cases with highly suspected EONS and 30 matched controls, was conducted. Besides the complete blood count and blood culture, C-reactive protein, procalcitonin, presepsin, IL-6, IL-8, and lactoferrin were measured at the admission and after 72 hours.

Results: At the time of the admission, presepsin, procalcitonin, C-reactive protein, and IL-8 were significantly higher in the sepsis group. The levels of presepsin, procalcitonin, and IL-8 significantly decreased after 72 hours of the admission. Presepsin, procalcitonin, IL-8, and IL-6 showed a high diagnostic ability for sepsis at admission with area under the curve of 0.934, 0.798, 0.775, and 0.751, respectively. The cutoff values of presepsin, procalcitonin, IL-8, and IL-6 were 821 pg/mL, 2.3 ng/mL, 54 pg/mL, and 24 pg/mL, with a sensitivity of 88.9%, 72.2%, 83.3%, and 94.4% and specificity of 85.7%, 80.9%, 71.4%, and 52.4%, respectively. Lactoferrin had the lowest diagnostic ability with area under the curve of 0.558.

Implications for Practice: Presepsin was the most accurate biomarker followed by procalcitonin, IL-8, and IL-6 regarding the early diagnosis and management of EONS. The combination between these biomarkers is highly recommended.

Implications for Research: Further studies are needed to investigate the diagnostic ability of the combination of these biomarkers.

Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Messrs Ahmed and Tarek Mohammed); Departments of Clinical Pathology (Dr Bastawy) and Pediatrics and Neonatology (Drs Attalla and Yousef), Faculty of Medicine, Helwan University, Helwan, Cairo, Egypt; Faculty of Medicine, Misr University for Science & Technology, Giza, Egypt (Ms Abdelrazek); Internal Medicine Department, Saint Joseph University Medical Center, Paterson, NJ, USA (Mr. Fransawy Alkomos); and Neuromuscular Research Unit, Neurology and Neuropsychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt (Mr Ghareeb).

Correspondence: Ali Mahmoud Ahmed, MBBCh, or Abdelrahman Tarek Mohammed, MBBCh, Faculty of Medicine, Al-Azhar University, Almokhayam aldaem St, Nasr city, Cairo, 11513, Egypt ( or

Ali Mahmoud Ahmed and Abdelrahman Tarek Mohammed contributed equally to the work.

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses