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Updated: Oct 8, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Umbilical Cord Procalcitonin to Detect Early-Onset Sepsis in Newborns: A Promising Biomarker
O R E Dongen1, L M van Leeuwen1,2, P K de Groot3
1Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands.
Insights
Umbilical cord blood procalcitonin (PCT) can help identify early-onset sepsis (EOS) in newborns. However, maternal antibiotic treatment may affect PCT accuracy, indicating caution is needed.
Area of Science:
- Neonatal Medicine
- Biomarkers
- Infectious Disease
Background:
- High rates of antibiotic use for suspected early-onset sepsis (EOS) in neonates suggest overtreatment, as culture-proven sepsis is rare.
- Improved diagnostic tools are needed to optimize antibiotic stewardship in newborns.
Purpose of the Study:
- To evaluate the diagnostic accuracy of umbilical cord blood procalcitonin (PCT) for diagnosing EOS in newborns.
- To assess the influence of maternal antibiotic treatment on PCT levels.
Main Methods:
- Umbilical cord blood PCT levels were measured in 329 newborns (≥ 32 weeks gestation) categorized into: culture-proven/probable EOS, possible EOS, risk factors only, and healthy controls.
- Infant blood PCT and C-reactive protein (CRP) were also analyzed when clinically indicated.
- Maternal antibiotic administration and sample type (venous/arterial) were considered.
Main Results:
- Umbilical cord blood PCT was significantly elevated in newborns with confirmed EOS compared to controls.
- The sensitivity and specificity of cord blood PCT for EOS were 83% and 62% (cut-off 0.1 ng/mL), respectively.
- Antepartum maternal antibiotic use decreased postpartum PCT levels in both cord and infant blood.
Conclusions:
- Umbilical cord blood PCT is elevated in newborns with EOS but lower in those with only risk factors.
- PCT may aid in differentiating infected from non-infected newborns, but its reliability is diminished following maternal antibiotic treatment.
- Further research is needed to refine PCT's role in neonatal sepsis diagnosis amidst maternal antibiotic use.
Abstract:
Background: Up to 7% of neonates born in high-income countries receive antibiotics for suspected early-onset sepsis (EOS). Culture-proven neonatal sepsis has a prevalence of 0.2%, suggesting considerable overtreatment. We studied the diagnostic accuracy of umbilical cord blood and infant blood procalcitonin (PCT) in diagnosing EOS to improve antibiotic stewardship. Methods: Umbilical cord blood PCT was tested in newborns ≥ 32 weeks of gestation. Groups were defined as following: A) culture-proven or probable EOS (n = 25); B) Possible EOS, based on risk factors for which antibiotics were administered for <72 h (n = 49); C) Risk factor(s) for EOS without need for antibiotic treatment (n = 181); D) Healthy controls (n = 74). Additionally, venous or capillary blood PCT and C-reactive protein (CRP) were tested if blood drawing was necessary for standard care. Results: Between June 2019 and March 2021, 329 newborns were included. Umbilical cord blood PCT was significantly higher in group A than in group C and D. No difference between venous or arterial samples was found. Sensitivity and specificity for cord blood procalcitonin were 83 and 62%, respectively (cut-off 0.1 ng/mL). Antepartum maternal antibiotic administration was associated with decreased PCT levels in both cord blood and infant blood directly postpartum in all groups combined. Conclusion: Umbilical cord blood PCT levels are increased in newborns ≥32 weeks with a proven or probable EOS and low in newborns with risk factors for infection, but PCT seems not a reliable marker after maternal antibiotic treatment. PCT could be useful to distinguish infected from healthy newborns with or without EOS risk factors.
