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Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia.

Schlapbach LJ, Frey S, Bigler S, Manh-Nhi C, Aebi C, Nelle M, Nuoffer JM - BMC Pediatr (2011)

Bottom Line: The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l).Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery.In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Bern, Switzerland. luregn.schlapbach@gmail.com

ABSTRACT

Background: Vasopressin is one of the most important physiological stress and shock hormones. Copeptin, a stable vasopressin precursor, is a promising sepsis marker in adults. In contrast, its involvement in neonatal diseases remains unknown. The aim of this study was to establish copeptin concentrations in neonates of different stress states such as sepsis, chorioamnionitis and asphyxia.

Methods: Copeptin cord blood concentration was determined using the BRAHMS kryptor assay. Neonates with early-onset sepsis (EOS, n = 30), chorioamnionitis (n = 33) and asphyxia (n = 25) were compared to a control group of preterm and term (n = 155) neonates.

Results: Median copeptin concentration in cord blood was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin cord blood concentrations were non-normally distributed and increased with gestational age (p < 0.0001). Neonates born after vaginal compared to cesarean delivery had elevated copeptin levels (p < 0.0001). Copeptin correlated strongly with umbilical artery pH (Spearman's Rho -0.50, p < 0.0001), umbilical artery base excess (Rho -0.67, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001). No difference was found when comparing copeptin cord blood concentrations between neonates with EOS and controls (multivariate p = 0.30). The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l). Receiver-operating-characteristic curve analysis showed that copeptin cord blood concentrations were strongly associated with asphyxia: the area under the curve resulted at 0.91 (95%-CI 0.87-0.96, p < 0.0001). A cut-off of 400 pmol/l had a sensitivity of 92% and a specifity of 82% for asphyxia as defined in this study.

Conclusions: Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery. In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

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Copeptin concentration is increased after vaginal delivery. Copeptin cord blood concentrations according to the delivery mode are shown. The medians and the p-value of Mann-Whitney U test are shown. The dotted line indicates the detection limit (4.8 pmol/l).
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Figure 2: Copeptin concentration is increased after vaginal delivery. Copeptin cord blood concentrations according to the delivery mode are shown. The medians and the p-value of Mann-Whitney U test are shown. The dotted line indicates the detection limit (4.8 pmol/l).

Mentions: When analyzing copeptin cord blood concentrations in the whole study population (n = 243), median concentration was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin concentration correlated significantly with gestational age (Spearman's Rho 0.30, p < 0.0001, Figure 1), and birth weight (Rho 0.29, p < 0.0001), but did not differ between boys and girls (Mann-Whitney Z -10.98, p = 0.33). Infants after vaginal delivery compared to cesarean delivery had significantly higher copeptin levels (Mann-Whitney Z -7.32, p < 0.0001, Figure 2), even when adjusting for gestational age (p < 0.001). Copeptin cord blood concentration showed a strong negative correlation with umbilical artery pH (Rho -0.50, p < 0.0001) and umbilical artery base excess (Rho -0.67, p < 0.0001), see Figure 3. Similarly, copeptin concentration correlated strongly with pH (Rho -0.34, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001), see Figure 3. The correlations between copeptin and pH, base excess and lactate remained significant in subgroup analyses on very preterm, late preterm and term neonates (< 32, 32-36 6/7, ≥ 37 weeks gestational age, p < 0.05, details not shown).


Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia.

Schlapbach LJ, Frey S, Bigler S, Manh-Nhi C, Aebi C, Nelle M, Nuoffer JM - BMC Pediatr (2011)

Copeptin concentration is increased after vaginal delivery. Copeptin cord blood concentrations according to the delivery mode are shown. The medians and the p-value of Mann-Whitney U test are shown. The dotted line indicates the detection limit (4.8 pmol/l).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3118890&req=5

Figure 2: Copeptin concentration is increased after vaginal delivery. Copeptin cord blood concentrations according to the delivery mode are shown. The medians and the p-value of Mann-Whitney U test are shown. The dotted line indicates the detection limit (4.8 pmol/l).
Mentions: When analyzing copeptin cord blood concentrations in the whole study population (n = 243), median concentration was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin concentration correlated significantly with gestational age (Spearman's Rho 0.30, p < 0.0001, Figure 1), and birth weight (Rho 0.29, p < 0.0001), but did not differ between boys and girls (Mann-Whitney Z -10.98, p = 0.33). Infants after vaginal delivery compared to cesarean delivery had significantly higher copeptin levels (Mann-Whitney Z -7.32, p < 0.0001, Figure 2), even when adjusting for gestational age (p < 0.001). Copeptin cord blood concentration showed a strong negative correlation with umbilical artery pH (Rho -0.50, p < 0.0001) and umbilical artery base excess (Rho -0.67, p < 0.0001), see Figure 3. Similarly, copeptin concentration correlated strongly with pH (Rho -0.34, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001), see Figure 3. The correlations between copeptin and pH, base excess and lactate remained significant in subgroup analyses on very preterm, late preterm and term neonates (< 32, 32-36 6/7, ≥ 37 weeks gestational age, p < 0.05, details not shown).

Bottom Line: The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l).Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery.In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Bern, Switzerland. luregn.schlapbach@gmail.com

ABSTRACT

Background: Vasopressin is one of the most important physiological stress and shock hormones. Copeptin, a stable vasopressin precursor, is a promising sepsis marker in adults. In contrast, its involvement in neonatal diseases remains unknown. The aim of this study was to establish copeptin concentrations in neonates of different stress states such as sepsis, chorioamnionitis and asphyxia.

Methods: Copeptin cord blood concentration was determined using the BRAHMS kryptor assay. Neonates with early-onset sepsis (EOS, n = 30), chorioamnionitis (n = 33) and asphyxia (n = 25) were compared to a control group of preterm and term (n = 155) neonates.

Results: Median copeptin concentration in cord blood was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin cord blood concentrations were non-normally distributed and increased with gestational age (p < 0.0001). Neonates born after vaginal compared to cesarean delivery had elevated copeptin levels (p < 0.0001). Copeptin correlated strongly with umbilical artery pH (Spearman's Rho -0.50, p < 0.0001), umbilical artery base excess (Rho -0.67, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001). No difference was found when comparing copeptin cord blood concentrations between neonates with EOS and controls (multivariate p = 0.30). The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l). Receiver-operating-characteristic curve analysis showed that copeptin cord blood concentrations were strongly associated with asphyxia: the area under the curve resulted at 0.91 (95%-CI 0.87-0.96, p < 0.0001). A cut-off of 400 pmol/l had a sensitivity of 92% and a specifity of 82% for asphyxia as defined in this study.

Conclusions: Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery. In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.

Show MeSH
Related in: MedlinePlus