YENİDOĞAN YOĞUN BAKIM ÜNİTESİ’NDE YENİDOĞAN SEPSİSİ TANISI ALAN HASTALAR İLE ENFEKSİYON KAYNAKLI OLMAYAN SOLUNUM SIKINTISI İLE İZLENEN HASTALARIN PROKALSİTONİN VE DİĞER ENFEKSİYON BELİRTEÇLERİNİN KARŞILAŞTIRMALI İNCELEMESİ

Abstract

Türker E., Comparative Study of Procalcitonin and Other Infection Markers in Patients Diagnosed with Neonatal Sepsis and Patients with Non-infectious Respiratory Distress Followed in the Neonatal Intensive Care Unit, Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, 2024. Respiratory distress is a common condition encountered in the neonatal period and is also commonly seen in early neonatal sepsis; therefore, patients with respiratory distress may need to be investigated for infection. It has been indicated in the literature that procalcitonin, routinely used for sepsis, may also rise in non-infectious respiratory distress. This study aims to compare the results of procalcitonin and other tests obtained from patients with respiratory distress in patients with and without infection and to determine the tests and cut-off values that can be used for infection differentiation. This study was conducted by retrospectively examining 436 patients admitted to the Neonatal Intensive Care Unit of Hacettepe University Ihsan Doğramacı Children's Hospital between January 1, 2017, and December 31, 2023, who had procalcitonin and other acute phase markers obtained within the first five days following birth. The average gestational age of the patients was 35,6±3,4 weeks; 232 (53.2%) were premature and 204 (46.8%) were term infants. When patients were examined according to gestational age, it was observed that only term patients in the control group had higher values for procalcitonin compared to premature infants, and there was no significant difference between terms and prematures in other groups. CRP levels in term patients were higher compared to prematures in the YGT and control groups. There was no significant difference in CRP levels between RDS and pneumonia patients according to gestational age. Sepsis was present in 74 (17%) of the 436 patients, and almost all of these were early neonatal sepsis. The most common finding in patients considered as clinical sepsis was respiratory distress, with a rate of 69.3%; 24.8% of these patients were diagnosed with sepsis. Patients were classified into four groups according to the presence of respiratory distress and infection: those without infection and respiratory distress (group a/control), those with non-infectious respiratory distress (group b/YGT-RDS), those without respiratory distress but with infection (group c/urinary tract infection-meningitis-omphalitis), and those with both infection and respiratory distress (group d/pneumonia). There was no significant difference between groups in terms of CRP according to the presence of respiratory distress and infection; however, for procalcitonin, the results of patients with respiratory distress were higher compared to the control group. When patients with respiratory distress with and without infection were compared, significant differences were found in procalcitonin and leukocyte count in the test results, with higher levels in those with infection; for a procalcitonin cut-off value of 4.8 ng/ml, the sensitivity and specificity for infection differentiation were determined as 58.7%. With this thesis study, it was concluded that procalcitonin levels may also be high in patients with respiratory distress without infection, alone these tests cannot be used to differentiate infection in patients with respiratory distress, the tests of YGT patients and pneumonia patients resulted in similar results, and these tests cannot distinguish between the two diagnoses.