Sepsis Biomarkers in Neonates and Children: C-Reactive Protein and Procalcitonin

Bacteremia and sepsis, along with other serious bacterial infections (SBIs), are still significant causes of morbidity and mortality among children worldwide despite the use of modern antibiotics and evidence-based resuscitation guidelines and treatments.1 Sepsis in neonates is a significant contributor to morbidity and mortality. Based on the onset, neonatal sepsis is classified into two major categories: early onset sepsis (EOS) and late onset sepsis. In the literature, however, there is little consensus as towhat age limits apply, with EOS ranging from 48 hours to 6 days after delivery. Early recognition of bacterial sepsis and initiation of therapy is associated with better treatment outcomes but is challenging asmanyof the early clinical features can be similar to those in self-limiting viral illnesses.2 In a studyofmore than 400 children with meningococcal sepsis in the United Kingdom, only half were referred to hospital at their first primary care consultation, usually after a delay of several hours following the first symptoms and/or signs of sepsis.3 Diagnosis of bacteremia is also challenging because the use of blood culture, the gold standard for diagnosis of bacteremia, is fraught with difficulties. First, incubation of bacteria may take several days (2–4 days). Second, genuine