Predictors of early-onset neonatal infections (review)

Infections of the early neonatal period and neonatal sepsis are the most common cause of critical condition, various complications and unfavorable outcome of the disease, both in the early and distant periods, but there are currently no reliable criteria for diagnosis, which makes it difficult to recognize the infectious process early. Based on the results of numerous studies, it was found that the clinical blood test has extremely low clinical value for the diagnosis of infections and early neonatal sepsis. It was found that the concentration of C-reactive protein in the blood rises 10–12 hours after the appearance of the first clinical manifestations of infection and peaks 48 hours later. An increase in C-reactive protein to 20 mg/L 48 hours after birth is possible even in newborns without infection, so its use as a marker of infections of the early neonatal period is very difficult. The threshold for C-reactive protein concentration in the first days of life is 10 mg/L. Premature babies have lower C-reactive protein values compared to full-term newborns. Increasing the concentration of procalcitonin, as well as C-reactive protein, immediately after birth is physiological, which limits their diagnostic value in the first 2–4 days of life. The procalcitonin concentration study is more justified for making an informed decision to discontinue antibacterial therapy. Presepsin is one of the earliest markers of a severe course of infections in newborns, since its concentration does not depend on the term of gestation. The level of N-terminal pro-BNP can be used as a marker of cardiovascular dysfunction, an increase in its level is associated with the severity of the infectious process and fatal outcome. A universal marker of infections of the early neonatal period and sepsis in newborns is currently absent, which indicates the need for a thorough assessment of all available clinical and laboratory tests over time.