CAPILLARY GLYCAEMIA AS AN EARLY MARKER OF NOSOCOMIAL INFECTION IN THE NEWBORN

Introduction CRP is a late marker of sepsis and PCT is an early but expensive marker. Predictive value of capillary glycaemia (CG) as an early marker of nosocomial sepsis in the newborn was investigated and compared to those of CRP and PCT.

Population and Methods A prospective study included all newborns ⩾7 days of age that presented at least two clinical criteria of sepsis. Diagnostic properties of tests were investigated by ROC analysis. Sensitivity (Se), specificity (Sp), likelihood ratio for a positive (LR+) and a negative (LR−) result for selected cut off point were also assessed.

Results Thirty-five situations met clinical criteria for sepsis. Data from 24 infected infants were compared to those of 11 non-infected. At inclusion, CG was significantly higher in the infected group (8.5 vs 6.1 mmol/L, p = 0.048). Area under ROC curve was 0.71 for CG (p = 0.049), 0.89 for CRP (p<104) and 0.90 for PCT (p<104). The best LR+ was 4.58 for a threshold value of 9.1 mmol/L (Se 41.6%, Sp 99.9%). Best LR+ for CRP and PCT was respectively 9.62 and 8.70 for a threshold value of 2 mg/L and 0.40 ng/ml. LR− <0.1 was obtained for a CG  = 6.1 mmol/L (Se 95.8%, Sp 45.4%).

Conclusion There was a significant increase in CG in neonatal nosocomial sepsis. CRP and PCT were found to be superior markers of sepsis when compared with CG. However, CG is an interesting predictive marker and may allow elimination of sepsis when it is below 6 mmol/L.