Abstract 1589 Poster Session II, Sunday, 5/2 (poster 104)

Procalcitonin (PCT) has been proposed as a sensitive and specific marker of severe bacterial infection.

The aim of this work was to assess the ability of PCT to detect septic complications after surgery in newborns.

Methods: In a prospective, descriptive and longitudinal study, serum PCT levels was assessed by a specific immunoluminometric assay before surgery and during the first 5 postoperative days in 51 surgical procedure (inguinal hernia excluded) performed in 41 neonates (mean weight ± SEM (range) = 2,451 ± 161 g (660-5,250)). Perisurgical antibioprophylaxis was systematically delivered during 24 hours after surgery using amikacin (10 mg/kg/d), penicillin G (200,000 UI/kg/d) and ornidazole (60 mg/kg/d if the gastro-intestinal tract was involved). Six infants were excluded from the study because they had a preoperative value of PCT above the threshold value (* 5 ng/ml) while no bacterial infection could be diagnosed.

Results: A significant rise of PCT was observed between values obtained before surgery and one day after surgery (mean ± SEM = 1.0 ± 0.2 ng/ml and 16.5 ± 6.6 ng/ml respectively; p = 0.028). No septic complications could be diagnosed in all cases. PCT raised over 5 ng/ml significantly more frequently after digestive surgery than after thoracic surgery (15/37 cases (41%) vs 1/8 case (13%); X2 test p=0.001). No pulmonary, digestive, cardiac complications occurred in the early postoperative period, except in one patient who suffered from a severe pulmonary oedema after enterolysis (PCT = 233 ng/ml). Between the first and the fifth postoperative day PCT decreased significantly (p = 0.036) to reach a mean ± SEM level under the threshold value (2.3 ± 0.6 ng/ml). In two cases a sepsis was diagnosed the fifth postoperative day (blood culture positive for Escherischia coli and Pseudomonas aeruginosa associated with clinical symptoma of sepsis); in both cases serum PCT raised contemporary of the diagnosis of the sepsis between the third and the fifth postoperative day from 2.4 and 5.4 ng/ml to 14.2 and 11.7 ng/ml respectively.

Conclusion: We concluded that PCT exhibited an early and transient increase in serum levels after surgery in neonates in absence of any bacterial infection. Elevated levels of PCT following surgery should be interpreted cautiously, with regards to the site of surgery and pulmonary complications. However we suggest that PCT response after surgery in newborns could help for the diagnosis of late bacterial infection if serial sequence of PCT is performed. We postulate that elevated PCT could be observed in case of severe tissue injury as represented by the neonatal abdominal surgery.