Maternal Serum Procalcitonin as a Predictor of Early-Onset Neonatal Sepsis in Preterm Premature Rupture of Membranes: A Study in a Tertiary Care Hospital in Bangladesh

Open Access

Abstract

Background: Preterm premature rupture of membrane (PPROM) increases early-onset neonatal sepsis risk, but diagnosis is challenging due to nonspecific symptoms. Maternal procalcitonin (PCT) is a promising biomarker, yet limited data exist on its predictive role for EONS. Objective: To determine the association between maternal serum procalcitonin level and early-onset neonatal sepsis in patients with PPROM at a tertiary care hospital in Bangladesh. 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 venous blood was collected on admission, and serum PCT was measured by chemiluminescence. Neonates were evaluated for EONS within 3 days of delivery using clinical signs, C-reactive protein, absolute neutrophil count, and blood culture results. Results: Elevated maternal serum procalcitonin (>0.5 ng/ml) was found in 61.6% of patients. Early-onset neonatal sepsis was confirmed by blood culture in 8 (8.9%) neonates. All eight cases of EONS occurred in the elevated maternal PCT group. The association was statistically significant (p=0.016, relative risk 1.74 at 95% CI). Neonates in the elevated PCT group also had significantly higher mean CRP (4.0±1.6 vs. 2.9±1.2 mg/l, p=0.001) and more frequent clinical signs of sepsis. Conclusion: Elevated maternal serum procalcitonin in PPROM is significantly associated with early-onset neonatal sepsis. Maternal PCT is a clinically useful, non-invasive biomarker for predicting EONS risk.