Role of Biomarkers in Neonatal Sepsis. Are we in search of the Holy Grail?
Keywords:Biomarkers, Neonatal Sepsis
Neonatal sepsis continues to be a common and significant health care burden, especially in very-low-birth-weight infants (<1500 g) with high mortality. The symptoms and signs are quite nonspecific resulting in under or over treatment with unnecessary antibiotics. The traditional markers like septic screen and hematological scores (total WBC count, Absolute Neutrophil count, IT ratio, peripheral smear), are a far cry from ideal. The gold standard blood culture including the Bactec is not full proof and time consuming. Acute phase reactant like C-Reactive Protein has good specificity, but poor sensitivity. Procalcitonin is expensive. The new biomarkers like Serum Amyloid A, Cytokines and chemokines like IL-6,IL-8, Tumour Necrosis Factor alpha, Cell surface markers like nCD64, the ‘Omics’ like Genomics, Metabolomics and Proteomics and the new biophysical markers like heart rate variability and core temperature differences, and the role of artificial intelligence (AI)in early diagnosis of sepsis are being discussed. The ultimate search for an ideal biomarker with 100% sensitivity and specificity is still going on, so that ultimately neonatal sepsis can be diagnosed before symptoms manifest resulting in early treatment and good prognosis.
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