Emerging biomarkers in neonatal sepsis

Approximately 30-40% of neonatal deaths are associated with bacterial infections, which often progress rapidly and result in high mortality. Because each year almost one million newborns die from infections, mostly in low-income countries, there is a need for a very early, accurate diagnosis of systemic inflammation and sepsis. On the other hand, in the era of multidrug resistance, it is mandatory to avoid unnecessary use of antibiotics to treat noninfected babies and to start the appropriate therapy in those with sepsis. Thus, rapid diagnostic test(s) that differentiate infected from noninfected newborns and surrogate biomarkers predicting outcome have the potential to significantly improve neonatal care. Various emerging biomarkers for neonatal sepsis have been recently proposed. Among these, the most promising biomarkers potentially measurable in clinical practice seem to be lipopolysaccharide-binding protein (LBP), soluble CD14 subtype presepsin (sCD14-ST) and angiopoietin-1 and -2 (ANG-1 and ANG-2, respectively). In the near future, metabolomics could offer a powerful tool to distinguish not only septic from nonseptic newborns, but also to identify without any overlap several clinical conditions associated with infections and inflammation, such as systemic inflammation, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock.