Serum Procalcitonin Assay for Investigations and Clinical Management of Neonatal Sepsis: A Review

The diagnosis and management of sepsis are very challenging especially in pediatric cases where the clinical criteria for the diagnosis overlap with nonbacterial etiologies of systemic inflammation. Initiation of antibiotic therapy for sepsis is necessary although the diagnostic evaluation is ongoing because delayed antibiotic therapy is associated with increased mortality. A highly sensitive and specific biomarker, such as procalcitonin, that improves decisions about initiating, discontinuing, or changing antibiotic therapy could have substantial clinical benefits of managing neonatal sepsis. This is a review of relevant published articles using extensive literature search made through google, PubMed/Medline, NLM, Scopus, and HINARI on randomized controlled and observational studies of procalcitonin-based diagnosis and antimicrobial-guided therapy especially in neonatal sepsis. Our systematic review found that procalcitonin-guided diagnosis, need for antibiotics, treatment evaluation give better outcome and prognosis than any other biomarker that were hitherto utilized in neonatal sepsis. Now that sepsis especially in children has become a frequent medical emergency, there is a need to extensively evaluate and possibly consider serum procalcitonin as an adjunctive marker to be combined with other commonly used approaches such as blood culture, full blood count, and differentials in order to enhance prompt and rational clinical management before blood culture results are available.