Procalcitonin as a Marker of the Systemic Inflammatory Response to Infection on Newborn and Children (up to 1 year)

GABRIEL ILYES1,2#, NARCISA CARMEN MLADIN3#, MARIUS CRAINA1, IZABELLA PETRE1, NICOLAE SUCIU4*, ANCA TUDOR5, ROXANA OANCEA6*, BOGDAN ANDOR7#, DANIELA RADU8 1Victor Babes University of Medicine and Pharmacy, Department XII, Discipline of Obstetrics and Gynecology, 2 Eftimie Murgu Sq., 300041,Timisoara, Romania 2 SC dr. Ilyes Stelian SRL, Arad, Romania 3. Vasile Goldis West University of Arad, Faculty of Medicine, Department of General Medicine, 94 Revolutiei Blvd.,310025, Arad, Romania 4Carol Davila University of Medicine and Pharmacy, Department of Obstetrics and Gynecology, Alessandrescu Rusescu Institute for Mother and Child Care, Bucharest,120 Lacul Tei Blvd., 020395, Romania 5Victor Babes University of Medicine and Pharmacy, Department of Functional Sciences,Medical Informatics and Biostatistics Discipline, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania 6Victor Babes University of Medicine and Pharmacy, Faculty of Dental Medicine, Department I, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania 7Victor Babes University of Medicine and Pharmacy, Department XVof Orthopedics, Traumatology, Urology and Imaging, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania 8Victor Babes University of Medicine and Pharmacy, Surgery Department, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania

In the last years, procalcitonin (PCT) has been proposed as an early marker of infections in newborns having registered different results. In this study, we aimed to investigate the value of serum procalcitonin for the diagnosis of sepsis in neonates and children procalcitonin in the diagnosis of neonatal sepsis and in children up to 1 year in the pathology of therespiratory system, gastrointestinal pathology, etc. At first, we established the clinical and paraclinical signs of systemic inflammation: increasing the temperature of the system, tachycardia, laboratory test: leukocytosis, C-reactive protein -for the diagnosis of sepsis.Some studies show that PCT gave a sensitivity between 83-100% and a specificity between 70-100% in early diagnosis of neonatal sepsis [1][2][3][4][5][6][7]; other researches question the accuracy of PCT in detecting neonatal sepsis.Procalcitonin (PCT) has been proposed as a marker of bacterial sepsis in critically ill patients. PCT is a precursor of calcitonin and a 116 amino acids protein. PCT levels more than 0.5 mg/dl are useful to determine the type of infectious process (bacterial or not).
Biomarkers are becoming more and more important in the early diagnosis of infectious disease. The characteristics of an ideal biomarker include excellent sensitivity and negative predictive value as well as excellent specificity and positive predictive value [8][9].
Biomarker levels that are found modified at the disease onset and afterwards could provide physicians the opportunity to correlate the results of the biomarker analyses in order to optimize clinical management, monitor disease progression, and guide anti-infective treatment [10][11][12][13].
Numerous studies and research in the field trying to elucidate the immune system of the newborn. In the past decade, more and more studies have been focused on this immune complex identifying and using various biomarkers having great potential for early diagnosis of sepsis and the pathology associated with pregnancy [14][15][16][17][18][19].
Bacterial endotoxins have a crucial role in the process of inducing this protein; Procalcitonin levels closely correlate with the severity and spread of the infection. Other factors that influence the level of procalcitonin are: the type and size of the infected organ, the bacterial species, the degree of inflammation and the immune reactivity of the body. PCT becomes measurable within 2-4 hours of the trigger event, reaching maximum levels after 12-24 hours [25][26][27][28][29][30].
With the increase in the incidence of obesity worldwide, DZ prevalence predisposes some women to gestational diabetes. The association between DZ and pregnancy can seriously affect the health of the mother and the future fetus (congenital malformations). Although maternal death is unusual, it may occur in association with other pathologies associated with pregnancy (preeclampsia, renal disease, ketoacidosis, HTAIS) [31][32][33][34][35][36][37][38].

Experimental part Material and method
Our sample contains 134 subjects (67 newborns and 67 children). We considered the main diagnosis and the results of the PCT intervals. Diagnosis at admission was divided into three categories: abdominal pathology, respiratory and other pathologies. The PCT intervals have been considered from the literature of speciality. The data was processed using SPSS v17 statistical package and Microsoft Excel software. The nominal data were compared with Chi-Square Test and the associations between these categorial series were achieved also with Chi2 Test.
The Odds Ratio (OR) and the confidence interval for OR were calculated by risk analysis. For OR> 1 and if the confidence interval for OR does not contain 1, the risk factor is considered to exist. For p<0.05 were considered statistical significance.

Results and discussions
Between the PCT reference intervals and the associated pathology, a significant association was determined (Chisquare Test, p<0.001) (table 1).
By comparing the percentages for each PCT reference interval between abdominal and respiratory pathology (Chisquare Test) we obtained statistical differences as follows: -for normal PCT values, the abdominal percentage was significant greater than the respiratory percentage, which is equivalent to the fact that the percentage of children with pathological PCT values is significantly increased in the case of respirator y pathology compared to the abdominal (p=0.029).
Respiratory pathology is a risk factor for increasing PCT values (Odds Ratio = 6.09 with the confidence interval [1.27; 29.29] and with a 87% specificity) (table 2).
No significant differences were found between the proportions of newborns and children by PCT reference intervals groups (Chi-square Test. p=0.194).
We plotted the comparison between children and newborns for the PCT values ( fig. 3).

Conclusions
Regarding the newborn. the immune function is dependent on the gestational age at which birth has been occurred. resulting in increased susceptibility to infection leading to an increased risk of morbidity and mortality due to sepsis.