Elsevier

The Journal of Pediatrics

Volume 154, Issue 4, April 2009, Pages 620-622.e1
The Journal of Pediatrics

Clinical and laboratory observation
The Role of Inter-Alpha Inhibitor Proteins in the Diagnosis of Neonatal Sepsis

https://doi.org/10.1016/j.jpeds.2008.10.008Get rights and content

We evaluated Inter-alpha inhibitor proteins (IaIp) as a diagnostic marker in neonatal sepsis. Samples were collected from 573 neonates who were examined for suspected sepsis. IaIp level was significantly lower in the septic group (121 ± 71 mg/L) than in the non-septic group (322 ± 91 mg/L). The optimal cutoff value with the receiver operating characteristic curve was ≤177 mg/L (sensitivity, 89.5%; specificity, 99%; positive predictive value, 95%; negative predictive value, 98%) with area under the curve of 0.94. IaIp is a more reliable diagnostic marker for neonatal sepsis than other available tests.

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Methods

This study was conducted in the neonatal intensive care unit of Women & Infants' Hospital of Rhode Island between August 2003 and January 2004. Residual blood samples of neonates who were examined for suspected sepsis were collected. An evaluation for neonatal sepsis was done at the discretion of the neonatal providers for a variety of reasons, including maternal risk factors and signs of neonatal sepsis. Routine sepsis evaluations included a full blood count, platelet count, and blood culture.

Results

A total of 573 neonates were examined for sepsis, 45 of whom had blood culture-proven sepsis (7.5%). The identified bacteria included Staphylococcus aureus (n = 2), group B Streptococcus (n = 2), Escherichia coli (n = 5), Citrobacter species (n = 2), Enterococcus fecalis (n = 4), Klebsiella species (n = 2), coagulase-negative Staphylococcus (n = 13), other gram-positive cocci (n = 9), and Candida species (n = 7). Patients in the septic group had a lower gestational age compared with patients in

Discussion

The IaIp family is a group of plasma-associated serine protease inhibitors synthesized mainly in the liver.9 In adult patients with sepsis, plasma levels are significantly decreased (by 20%-90%) and inversely correlated with unfavorable outcome.7 In neonates, we previously studied a cohort of newborn infants with a gestational age between 24 and 42 weeks and found the circulating concentration of IaIp to be endogenously produced independent of gestational age, independent of postnatal age, and

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Lim holds a significant interest in Prothera Biologics, which supported these studies by performing the IaIp assays. None of the other authors declare conflicts of interest

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