This document discusses biomarkers for the diagnosis of neonatal sepsis. It begins with an introduction that notes neonatal sepsis (NS) is an important factor in neonatal mortality and morbidity. Early diagnosis and treatment of suspected sepsis is critical to prevent life-threatening complications. However, diagnosis of NS is challenging due to non-specific clinical signs and difficulty interpreting infection markers in the first phase of NS. The aim is to summarize information on traditional biomarkers like CRP and hematological indices, provide an overview of newer biomarkers from PCR and "omic" technology, and discuss any changes or newer biomarkers that may be relevant in the post-COVID era of neonatal medicine.

1. Neonatal sepsis biomarkers: where are we
n o w ?
BIOMARKERS OF NEONATAL SEPSIS
DR AKSHAY P JADHAV,
MD (Peds),
[Fellow Ped ER/ICU],
Consultant Pediatrician,
Femiint Health Clinic and Hospital, Bengaluru, KA, IN
Consultant Pediatrician and Chief, Division Peds,
ARK Adv Multispeciality Clinic & Diagnostic Centre, Marathahalli, Bengaluru, KA, IN
Consultant Pediatrician,
Vitals Mother and Child Hospital, Seegahalli, Bengaluru, KA, IN.

2. a. Neonatal Sepsis (NS) remains an IMP factor contributing to mortality and
morbidity in neonates
b. Early diagnosis and treatment of the neonate with suspected sepsis are
essential to prevent life-threatening complications
c. Diagnosis of neonatal sepsis is a challenge due to non-specifi c clinical signs
and the fact that infection markers are diffi cult to interpret in the fi rst and
critical phase of neonatal sepsis.
d. Hence, identification of accurate biomarkers to aid in its timely and accurate
diagnosis is critical
e. The AIM of this presentation is a THREE PRONGED APPROACH:
f. Summarizing information regarding “traditional” biomarkers (eg,
hematological indices, CRP, and other acute-phase reactants, cytokines)
g. Overview of the latest clinical status on some relatively “newer” biomarkers
(eg, PCR- and “-omic” technology-based, biophysical biomarkers) in the
diagnosis of neonatal sepsis
h. Any changes / Scope of these Biomarkers/ ?Newer Ones, in the "post COVID
pandemic Era", and it's relevance to Neonatal Medicine
Introduction :

3. Biomarkers ? What are
t h e y ?
1
Newer Biomarkers in NS
3
Traditional Biomarkers in NS
2
Lessons learnt / Newer
Perspectives post COVID
P a n d e m i c E r a
4
C O N T E N T S

4. 01 Biomarkers ? What are
t h e y ?

5. Brief introduction:
NS and it's TYPES - EOS &
LOS
 Early-onset sepsis (EOS) refers to infection diagnosed in the first 72
hours of life with pathogens most likely acquired perinatally,
 In contrast, late-onset sepsis (LOS) refers to infection diagnosed
from day of life 4 onward, where the source is from either the
community or hospital environment,
 The challenge of diagnosing NS ---> both EOS and LOS often present
with Non-specific clinical signs that show significant overlap
with common uninfectious conditions, such as TTN (transitional
tachypnea) and AOP (apnea of prematurity.

6. Ideal Biomarker & it's Properties:
a. The ideal biomarker should demonstrate a consistent and
predictable pattern in both response to infection and to
treatment.
b. A high degree of sensitivity is essential to ensure that cases
are not missed;
c. However, specificity is also important to avoid exposing
unaffected infants to unnecessary treatment.
d. The perfect biomarker should also be able to give:
e. Prognostic information,
f. An indication of the identity of the pathogen,
g. Be easily measured with a technique that guarantees a fast
turnaround,
h. If a serum sample is required, should only require a minimal

7. Ideal Biomarker?

8. Biomarkers in action

9. CRP (C Reactive Protein)
- Most thoroughly studied acute phase protein is C-reactive protein (CRP)
- CRP is induced by interleukin-6 (IL-6), and is hence not the earliest
marker to rise in the case of infection
- It rises within 6-8 hours after onset of infection and peaks 24-48 hours
later.
- It has a half life of 19 hours, and has the capacity for a 1000 fold increase
- Hence, CRP is not a good screening test to detect sepsis at an early
stage
- It is a suitable ruling-out test that can support the discontinuation of
antibiotics when repeated measures over a 48 hour period remain negative

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25. E WA F E WA F O
THANK YOU