Elevated Maternal Procalcitonin and Neonatal Outcomes in Preterm Premature Rupture of Membranes: A Prospective Cohort Study

Open Access

Abstract

Background: Preterm premature rupture of membranes (PPROM) is a leading cause of neonatal morbidity and mortality. Maternal procalcitonin (PCT) has emerged as a potential biomarker for intra-amniotic infection, but its association with comprehensive neonatal outcomes beyond early-onset sepsis remains incompletely characterized. Objective: To evaluate the association between elevated maternal serum procalcitonin levels and adverse neonatal outcomes in women with PPROM. Methods & Materials: This prospective cohort study was conducted at Dhaka Medical College Hospital from January to December 2022. A total of 99 women with PPROM (24-34 weeks of gestation) were enrolled. Maternal serum PCT was measured on admission. Neonates were followed for clinical signs, laboratory parameters, blood culture-proven sepsis, NICU admission, and mortality within 3 postnatal days. Results: Elevated maternal PCT (>0.5 ng/ml) occurred in 61.6% of patients. The elevated PCT group showed significantly higher rates of lethargy (27.3% vs. 2.9%, p=0.003), respiratory distress (16.4% vs. 0.0%, p=0.010), fever (38.2% vs. 8.6%, p=0.002), and hypotonia (14.5% vs. 0.0%, p=0.017). Mean neonatal CRP was higher (4.0 vs. 2.9 mg/L, p=0.001) and ANC lower (4794.5 vs. 5489.9 cells/µL, p=0.047) in the elevated PCT group. Blood culture positivity (p=0.016), NICU admission (24.2%), and mortality (9.1%) occurred exclusively in the elevated PCT group. Conclusion: Elevated maternal serum procalcitonin in PPROM is significantly associated with adverse neonatal outcomes, including clinical sepsis, positive blood culture, NICU admission, and mortality. Maternal PCT is a valuable non-invasive predictor of poor neonatal prognosis.