Markers to diagnose neonatal sepsis

[harnon]

I an interested to know what diagnostic markers you are using in your daily work, to diagnose early/late onset infection in term/preterm infants:

1. Clinical signs
2. CBC and differentials
3. CRP
4. Clinical score (HR variability etc. )
5. Acute phase reactant (ie; Procalcitonin, SAA etc)
6. Cytokines and\or chemokines (ie IL-6, IL-8, 10 etc
7. Leukocyte surface antigen (CD11b, CD64 etc)
8. Molecular techniques : PCRs or FISH to detect bacteria

Is there any difference applying these markers in preterm or term infant?
Or in early Vs. late infection?

S Arnon
harnon@netvision.net.il

[aveles]

we are using in daily work diagnostic markers; 1. Clinical signs
2. CBC and periferal smear
3. CRP
4. Clinical score (HR variability )
5. Acute phase reactant ( Procalcitonin)

[fcardona]

Hi,
we start with clinical signs, then CBC and peripheral smear (IT-ratio), CRP and IL-8 (at night we only get IL-6, dont ask me why..), we do blood cultures and work-up of other areas, but these tend to be negative often. We rarely do LP, unless we have the suspicion that something is going on in the brain (e.g. seizures). We are currently also seeing if PCR is feasible for these small babies as well... I am not aware of any difference of these markers in preterm or term infants, although it might take more than one sepsis work-up to find higher diagnostic markers in a child that seems clinically ill. Dont know about any evidence on that matter.
Any of you use TNF-alpha? I read an interesting paper - in adults though - that higher TNFalpha values in shock correlate with better outcome, which is somewhat surprising and completely contrary to conventional wisdom PlosONE (http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0008406)
Also have a look into this paper especially if you are in the developing world - Plos: New approaches (http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1000213)