Preliminary Study Of Pro-Vasoactive Peptide For In Neonate With Severe Infection

OBJECTIVE The low immunity of neonate,particularly the premature and the very low birth weight infant,results in the high incidence of infection.The infection tend to be severe in newboms,which continue to be major cause of mortality.The clinical manifestations of neonatal infection is non-typical and various which makes the early diagnosis the most important point to improving the prognosis.The purpose of the study is to assay the concentration of proadrenomedullin(pro-ADM),pro-atrial natriuretic peptide(pro-ANP),pro-endothelinl(pro-ET) and copeptin in neonates,by which to explore,first,the correlation between the level of pro-vasoactive peptide and the gestational age,birth weight,age and the severity of infection;second,the diagnostic efficiency of pro-vasoactive peptide in the neonate with severe infection; third,the correlation between the level of pro-vasoactive peptide and the severity and the prognosis of the neonates.METHODS Three hundred and fifty six neonates were selected from the neonatal division in Children Hospital of Fudan University from April to December in 2007.There were 169 preterm infants and 187 full-term infants.The neonates with the congenital malformation,congenial metabolic disease and severe asphyxia were excluded.The patients were divided into three groups:non-infection group(160), mild infection group(114),severe infection group(82).According to the severity of disease,the patients in the severe infection group was subdivided into two groups: critical group and non-critical group.The 1mL blood in patients of infection groups were collected in 48 hours after infection,while the blood in the non-infection patients were colleceted during hospitalization.Serum level of pro-ADM,pro-ANP, pro-ET and pro-AVP were determined by Immunoluminometric Assay(ILMA).The clinical data including birth weight,gestational age,age,complete blood count, C-reactive protein(CRP),prothyrocalcitonin(PCT),blood culture,X-ray,CSF analysis and culture,the treatment and outcome were recorded.The data were analysed by SAS and the state sofeware.RESULTS 1.The level of pro-ADM,pro-ANP,pro-ET and copeptin were detected in newborns.Using the multiple linear regression analysis we found that among the infection,gestational age,birth weight and the days,the infection is the independent influencing factor for the variation of the level of pro-ADM,pro-ANP and pro-ET.There were positive correlation between the level of pro-ADM,pro-ANP, pro-ET and the severity of infection(P＜0.0001).The level of pro-ANP declined with the increasing gestational age(P＜0.05).There was no correlation between the level of copeptin and infection.The age was the influncing factor.2.The pro-ET,pro-ADM and pro-ANP had good diagnostic efficiency for neonatal infection.CRP had high specificity,however,the sensitivity was low,just 23.47%.Combined with the AUC, among them pro-ADM had highest diagnostic efficiency,and the sensitivity and specificity was 82.65%and 61.25%,respectively.The positive predictive value and negnative predictive value were 68.08%and 77.93%,respectively.3.The level of pro-ADM in neonates with positive blood culture sepsis(2.488±1.288 nmol/L) was significant higher than that of patient with negative blood culture(1.899±1.117nmol/L) (P＜0.05),while the level of pro-ET and pro-ANP between neonates with positive blood culture and patient with negative blood culture showed no significant difference (P＞0.05).pro-ET,pro-ADM and pro-ANP had good diagnostic efficiency for severe infection.CRP had high specificity,however,the sensitivity was low,just 42.68%. Combined with the AUC,among them pro-ADM had highest diagnostic efficiency, and the sensitivity and specificity was 71.95%and 87.23%,respectively.The positive predictive value and negnative predictive value were 84.93%and 75.67%, respectively.The level of pro-ADM in critical patient(2.498±1.140nmol/L) was significant higher than that of non-critical patient(1.810±1.162nmol/L)(P＜0.05). 4.The concentration of pro-ANP was significant higher in non-survivors (1680.93±712.88pmol/L) than that of survivors(1185.85±767.09pmol/L)(P＜0.05).CONCLUSION The severity of infection was the major factor for the variation of pro-ADM,pro-ANP and pro-ET level in newborns,while there was no correlation between the level of copeptin and infection.The sensitivity and specificity of Pro-ET were high in the diagnosis of neonatal infection,and its diagnostic efficiency was better than that of CRP.The sensitivity and specificity of Pro-ADM were high in the diagnosis of severe neonatal infection,and its diagnostic efficiency was better than those of Pro-ET,pro-ANP and CRP.The level of pro-ADM was helpful to evalute the critical condition of severe infection,while the level of pro-ANP may be a good marker to predict the poor outcome in neonate with severe infection.