Umbilical blood biomarkers for predicting early-onset neonatal sepsis

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Umbilical blood biomarkers for predicting early-onset neonatal sepsis Ying Fan, Jia-Lin Yu Chongqing, China

Data sources: We searched PubMed and Elsevier's Web of Science for studies evaluating cord blood inflammatory markers in relation to early-onset neonatal sepsis. R e s u l t s : A m o n g C - re a c t i v e p ro t e i n ( C R P ) , procalcitonin (PCT), IL-6, IL-8, TNF-α and IL-1β, none of them could be used individually to establish or exclude the diagnosis of early-onset neonatal sepsis, but PCT, IL-6 and IL-8 have great superiority to CRP, TNF-α and IL-1β. When combined with other hematological markers and clinical observation, the clinical reliability of PCT, IL-6 and IL-8 could be improved. Prolonging the sample collection time window seems to have a positive effect on the clinical utility of IL-6 and IL-8. Conclusions: More researches focusing on the combination of different umbilical cord biomarkers in different clinical settings are needed to achieve clearer conclusions. Multi-center, large-sized analysis, especially examining groups of cytokines, is also expected. World J Pediatr 2012;8(2):101-108

Author Affiliations: Department of Neonatology, Institute of Pediatrics, Chongqing Medical University, Chongqing 400014, China (Fan Y, Yu JL) Corresponding Author: Jia-Lin Yu, Department of Neonatology, Institute of Pediatrics, Chongqing Medical University, Chongqing 400014, China (Tel: +86-13896069217; Email: [email protected]) doi: 10.1007/s12519-012-0347-3 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2012. All rights reserved.

World J Pediatr, Vol 8 No 2 . May 15, 2012 . www.wjpch.com

Key words: C-reactive protein; interleukins; neonatal sepsis; procalcitonin

Introduction

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ccording to the 2002 International Pediatric Sepsis Consensus Conference, pediatric sepsis is defined as systemic inflammatory response syndrome in the presence of or as a result of suspected or proven infection. [1] But so far, a worldwide agreement on the definition of early-onset neonatal sepsis (EONS) has not been reached. In this review, we aim to integrate the previous literatures investigating biomarkers in cord blood at birth for the immediate diagnosis of EONS. Cord blood is the earliest hematologic sample from the object, which could guide the clinicians to carry out effective therapeutic strategy as soon as possible. Besides, a painless and noninvasive manipulation avoids iatrogenic stress source to vulnerable newborns, which could cause deterioration and possible anemia. Theoretically, the ideal markers for detecting EONS should have the highest sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and optimal likelihood ratio (LR), which means a LR(+)>10 and LR(-)

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