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Effect of the systemic inflammatory response on biochemical markers of neonatal bacterial infection: a fresh look at old confounders.

“Rule out sepsis” remains a persistently frustrating diagnosis in neonatology. It a common diagnosis: in the US, where 400 000 to 600 000 newborns are evaluated with a complete blood count (CBC) and blood culture each year, it is probably the second most common neonatal diagnosis after “well baby” (1)(2)(3). No one disputes that babies with clear-cut clinical signs of infection should receive systemic antibiotic therapy. However, beyond these two facts, and despite individual nursery protocols somehow keeping the problem—more or less—under control, multiple disagreements exist. Discord is most pronounced in two areas. The first is what test or combinations of tests permit one to diagnose sepsis early enough and reliably enough. After all, by the time a newborn shows clear-cut signs of infection, it is usually pretty late in the game (1). The second concerns newborns with maternal risk factors who are initially asymptomatic: what constitute appropriate criteria for initiating antibiotic therapy in such infants (4)(5)(6)?

Faced with these questions, many investigators have attempted to find the diagnostic equivalent of a “magic bullet”, and a voluminous literature now exists advocating individual diagnostic tests or combinations of diagnostic tests, as well as combinations of a diagnostic test or tests with risk factors and/or clinical signs. All of these studies have yielded conflicting results, and the fact that these studies keep appearing in our journals highlights the fact that satisfactory solutions remain to be found.

In this issue, Chiesa et …