Turk J Pediatr. 2011 Mar-Apr;53(2):180-6.

Procalcitonin versus CRP as an early indicator of fetal infection in preterm premature rupture of membranes.
Canpolat FE, Yiit S, Korkmaz A, Yurdakk M, Tekinalp G.

Source
Neonatology Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Abstract
The aim of this study was to examine the diagnostic sensitivity and specificity of C-reactive protein (CRP) and procalcitonin (PCT) in neonates who were born after preterm premature rupture of membranes (PPROM) and compare these with interleukin-6 (IL-6). The study involved 74 preterm neonates who were born after PPROM. IL-6, CRP, complete blood count and leukocyte ratios, and PCT levels were measured in the 1st day of life, and CRP, PCT, and blood counts were repeated on the 3rd day of life. Seventy-four infants with PPROM were divided into two groups according to the development of sepsis and infection (Group 1: sepsis, n = 32; Group 2: no sepsis, n = 42). There were no significant differences between these groups with respect to gestational age, birthweight and duration of membrane rupture. There were significant differences between the two groups in the 1st day CRP (Group 1: 0.85 -/+ 1.36 mg/dl, Group 2: 0.23 +/- 0.25 mg/dl; p = 0.016), 1st day PCT (Group 1: 7.2 +/- 7.6 ng/ml, Group 2, 1.6 +/- 4.0 ng/ml; p < 0.001), and 3rd day PCT (Group 1: 9.01 +/-11.5 ng/ml, Group 2: 1.34 +/- 1.35 ng/ml; p = 0.001) and IL-6 (Group 1: 80.7 +/- 67.2 pg/ml, Group 2: 3.4 +/- 3.5 ng/ml; p < 0.001) levels. CRP levels were not significantly different between Group 1 (1.2 +/- 1.7 mg/dl) and Group 2 (0.58 +/- 1.1 mg/dl) on the 3rd day of life (p=0.059). CRP levels on the 1st day of life had a cut-off value of 0.72 mg/dl with a sensitivity and specificity of 56% and 58%, respectively. CRP levels on the 3rd day had a cut-off level of 0.78 mg/dl with 60% sensitivity and 63% specificity. PCT levels had a cut-off level of 1.74 ng/ml with 76% sensitivity and 85% specificity on the 1st day of life, and of 1.8 with 89% sensitivity and 86% specificity on the 3rd day of life. Statistical analysis revealed that the cut-off value of 7.6 pg/ml for IL-6 had a 93% sensitivity and 96.7% specificity. Interleukin (IL)-6 is the most reliable marker for the detection of early-onset sepsis in preterm neonates with PPROM. Early PCT levels seemed to be more sensitive than early CRP in this population.

Bangladesh Med Res Counc Bull. 2011 Aug;37(2):40-6.

Role of serum procalcitonin and C-reactive protein in the diagnosis of neonatal sepsis.
Naher BS, Mannan MA, Noor K, Shahiddullah M.

Source
Department of Neonatology, Sir Salumullah Medical College & Mitford Hospital, Dhaka.

Abstract
This cross sectional observational study was done in the division of neonatology, department of pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) in the year 2007. The study population was 50 newborns in total who needed evaluation of sepsis on clinical suspicion. The main objective of this study was to assess serum procalcitonin (PCT) as a better diagnostic marker than C-Reactive Protein (CRP) in neonatal sepsis. The total study populations were classified into 4 groups like highly probable, probable, and possible and no sepsis group according to the clinical and blood parameters. PCT and CRP were assessed and compared by statistical analysis. For the estimation of PCT and CRP, venous blood was drawn and centrifuged and stored at - 20 degrees C in the refrigerator. Later on PCT was measured by rapid semi quantitative immunochromatographic test. Level of CRP was determined by semi quantitative method (latex). All data were analyzed by SPSS version 10 windows. For statistical analysis appropriate tests were done. In all observations sepsis was found to be more common in male newborns and in those who were delivered by caesarean section. In low birth weight and preterm newborns sepsis was more prevalent. Premature rupture of membrane (PROM) was found to be the commonest maternal clinical condition as a risk factor of sepsis. There was positive correlation between serum PCT and CRP and values of serum PCT as well as CRP differed significantly in the different categories of sepsis indicating relation to the severity of sepsis. PCT is a useful, sensitive and independent biomarker of neonatal sepsis. CRP measurement along with PCT measurement may increase the specificity. Though PCT measurement is comparatively expensive but an easy bed side promt convenient procedure for sick neonates in addition to CRP for rapid evaluation of neonatal sepsis rather than waiting for the report of blood culture.

Placenta. 2011 Oct;32(10):732-6. Epub 2011 Aug 11.

Predictive value of intra-amniotic and serum markers for inflammatory lesions of preterm placenta.
Oh KJ, Park KH, Kim SN, Jeong EH, Lee SY, Yoon HY.

Source
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.

Abstract

OBJECTIVE:

To compare the relative predictive values of amniotic fluid (AF) matrix metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), and serum C-reactive protein (CRP) for histologic chorioamnionitis and intra-amniotic infection in women with preterm labor or preterm premature rupture of membranes (PROM).
STUDY DESIGN:

This retrospective cohort study included 99 consecutive women with preterm labor or preterm PROM (21-35 weeks' gestation) who delivered within 72 h of transabdominal amniocentesis. The AF was cultured for aerobic and anaerobic bacteria and for genital mycoplasmas and was assayed for MMP-9 and IL-6 levels. Maternal serum CRP was measured immediately after amniocentesis. The placentas were examined histologically.
MAIN OUTCOME MEASURES:

histologic chorioamnionitis and intra-amniotic infection.

RESULTS:

The prevalence of histologic chorioamnionitis and a positive AF culture was 44% (44/99) and 28% (28/99), respectively. In predicting intra-amniotic infection, AF MMP-9 had a significantly higher area under the curve (AUC: 0.94 [95% CI, 0.87-0.98]) than AF IL-6 (0.87 [95% CI, 0.780.84]; P < 0.05) and serum CRP (0.76 [95% CI, 0.66-0.84]; P < 0.001) and a higher sensitivity and specificity than serum CRP (P < 0.01, respectively). However, in predicting histologic chorioamnionitis, there were no significant differences in AUCs among the three tests (AF MMP-9: 0.78 [95% CI, 0.68-0.85]; AF IL-6: 0.76 [95% CI, 0.66-0.84]; serum CRP: 0.76 [95% CI, 0.66-0.84]). In a sub-analysis of 71 women without intra-amniotic infection, histologic chorioamnionitis was associated with an elevated serum CRP level (P < 0.05), but not with the level of AF IL-6 or MMP-9 (P = 0.232 and P = 0.402, respectively).
CONCLUSIONS:

The AF MMP-9 has a better overall diagnostic performance than the AF IL-6 and maternal serum CRP in predicting intra-amniotic infection. However, the serum CRP level obtained up to 72 h before delivery appears to be an important marker for early identification of histologic chorioamnionitis in women without intra-amniotic infection. Copyright 2011 Elsevier Ltd. All rights reserved.

BMC Pregnancy Childbirth. 2011 Apr 7;11:26.

Maternal markers for detecting early-onset neonatal infection and chorioamnionitis in cases of premature rupture of membranes at or after 34 weeks of gestation: a two-center prospective study.
Popowski T, Goffinet F, Maillard F, Schmitz T, Leroy S, Kayem G.

Source
Epidemiological Research Unit on Perinatal and Women's Health, INSERM U953, Paris, France. thomas.popof@wanadoo.fr

Abstract
BACKGROUND:

Accurate prediction of infection, including maternal chorioamnionitis and early-onset neonatal infection, remains a critical challenge in cases of preterm rupture of membranes and may influence obstetrical management. The aim of our study was to investigate the predictive value for early-onset neonatal infection and maternal histological and clinical chorioamnionitis of maternal biological markers in routine use at or after 34 weeks of gestation in women with premature rupture of membranes.
METHODS:

We conducted a two-center prospective study of all women admitted for premature rupture of membranes at or after 34 weeks of gestation. The association of C-reactive protein, white blood cell count, vaginal sample bacteriological results, and a prediction model at admission, for earlyonset neonatal infection and maternal chorioamnionitis were analyzed by comparing areas under the receiver operating characteristic curves and specificity.
RESULTS:

The study included 399 women. In all, 4.3% of the newborns had an early-onset neonatal infection and 5.3% of the women had clinical chorioamnionitis. Histological chorioamnionitis was detected on 10.8% of 297 placentas tested. White blood cell counts and C-reactive protein concentrations were significantly associated with early-onset neonatal infection and included in a prediction model. The area under the receiver operating characteristic curve of this model was 0.82 (95% CI [0.72, 0.92]) and of C-reactive protein, 0.80 (95% CI [0.68, 0.92]) (p = 1.0). Specificity was significantly higher for C-reactive protein than for the prediction model (48% and 43% respectively, p < 0.05). C-reactive protein was associated with clinical and histological chorioamnionitis, with areas under the receiver operating characteristic curve of 0.61 (95% CI [0.48, 0.74]) and 0.62 (95% CI [0.47, 0.74]), respectively.

CONCLUSIONS:

The concentration of C-reactive protein at admission for premature rupture of membranes is the most accurate infectious marker for prediction of early-onset neonatal infection in routine use with a sensitivity > 90%. A useful next step would be a randomized prospective study of management strategy comparing CRP at admission with active management to assess whether this more individualized care is a safe alternative strategy in women with premature rupture of membranes at or after 34 weeks.

Bratisl Lek Listy. 2009;110(10):623-6.

Procalcitonin, neopterin and C-reactive protein in diagnostics of intrauterine infection and preterm delivery.
Greksova K, Parrak V, Chovancova D, Stencl P, Oravec J, Marsik L, Sysak R, Fuchs D, Peskova Z, Borovsky M.

Source
1st Department of Gynaecology and Obstetrics of Comenius University, Bratislava, Slovakia. katygreksova@gmail.com

Abstract
OBJECTIVE:

The purpose of this study was to find out whether Procalcitoni, Neopterin and C-reactive protein are sensitive and specific markers of intrauterine infection.
METHODS:

We evaluated 155 patients from 26. to 41. week of pregnancy at the time of delivery. We measured serum concentrations of procalcitonin (PCT), neopterin and C-reactive protein (CRP) from mother's blood sample at the beginning of delivery and from umbilical cord blood after delivery.
RESULTS:

In first group occurred in higher percentage (27.41%) preterm delivery (26.-37. week of pregnancy), chorioamnionitis confirmed by histological examination (16.12%) and preterm premature rupture of membranes (24.19%). In this group occured perinatal infection of newborn in 61.29%. In the second group preterm delivery (6.31%) and perinatal infection of newborn (7.36%) occured in lower percentage.

CONCLUSION:

The results suggest that the simultaneous measurement of CRP, PCT and NPT in mother's blood sample before delivery and umbilical cord blood may provide an accurate early diagnosis of infection and then preterm delivery (Tab. 1, Fig. 3, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

[Maternal serum cytokine levels in pregnancies complicated by PROM].

[Article in Polish] Poniedziaek-Czajkowska E, Leszczyska-Gorzelak B, Oleszczuk J.

Source
Kliniki Pooznictwa i Perinatologii II Katedry Pooznictwa i Chorb Kobiecych AM w Lublinie.

Abstract
OBJECTIVE:

The aim of the study was to evaluate the maternal serum cytokines levels in pregnancies complicated by premature rupture of membranes (PROM).
MATERIALS AND METHODS:

Maternal serum of IL-1 beta, IL-4, IL-6, IL-8 and TNF-alfa levels were assessed in patients with PROM between 24-34 weeks of pregnancy (n = 45). Control group consisted of healthy pregnant women (n = 41) at 24-34 weeks of gestation. Serum cytokines concentrations were measured by commercial available enzyme-linked immunosorbent assays. C-reactive protein level and WBC were estimated in both groups.
RESULTS:

Compared to healthy pregnant, the group of patients with PROM had significantly higher serum levels of IL-1 beta (0.76 pg/ml vs 0.41 pg/ml, p = 0.022), TNF-alfa (1332.46 pg/ml vs 58.01 pg/ml, p < 0.00001) and IL-8 (15.79 pg/ml vs 0 pg/ml, p < 0.00001). CRP concentration and WBC were also significantly higher in serum of pregnant women with PROM then in healthy ones (CRP: 10 mg/l vs 0 mg/l, p = 0.043; WBC: 13,188 +/- 3625/mm3 vs 9132 +/- 1913/mm3, p < 0.00001). No significant differences in IL-6 and IL-4 levels were found between groups.

CONCLUSION:

Differences in serum maternal levels of cytokines between patients with premature ruptures of membranes and healthy pregnant women suggest that reasons and/or consequences of PROM results in changes in immunological system.

WISER, A., SIVAN, E., DULITZKI, M., CHAYEN, B., SCHIFF, E., BAR-CHAIM, A. and SIMCHEN, M. J. (2008), Creactive protein and the mode of onset of labor in term pregnancies. Acta Obstetricia et Gynecologica Scandinavica, 87: 2630. doi: 10.1080/00016340701714661

Objective. To evaluate whether C-reactive protein (CRP) levels in maternal serum at post-date follow-up can predict the mode of onset of spontaneous delivery in term pregnancies and the interval to delivery. Study design. Women at 40 completed weeks of gestation were recruited. The interval from CRP sampling to delivery and mode of onset of delivery were noted. Results. Sixty women were divided into 3 groups according to the mode of onset of labor. Group A presented with spontaneous onset of contractions, Group B presented with pre-labor ruptured membranes (PROM), and Group C completed 42 weeks without spontaneous initiation of labor. There was no association between CRP values and latency from time of sampling to delivery. Mean serum CRP in Group B (12.7 mg/l) was significantly higher than in either Group A (7.2 mg/l) or Group C (10.2 mg/l) (p = 0.01). In addition, CRP values in the upper quartile (>12.2 mg/l) had a 37.5% positive predictive value for PROM, with a negative predictive value of 93%. Conclusion. Women whose labor will start with PROM have higher CRP values at post-date follow-up than women whose labor starts otherwise.