Relationship between intrapartum antibiotic prophylaxis and group B streptococcal colonization dynamics in Japanese mother–neonate pairs

IntroductionIn Japan, universal screening for group B streptococcal (GBS) colonization in pregnant women and intrapartum antibiotic prophylaxis (IAP) are recommended to prevent neonatal GBS infection. However, the dynamics of GBS colonization in Japanese mother/neonate pairs have not been adequately studied.MethodsA prospective cohort study was conducted from July 2018 to March 2019. Rectovaginal samples were collected from pregnant women (33–37 gestation weeks) once. In neonates, nasopharyngeal and rectal samples were collected at three time points: after birth, 1 week after birth, and 1 month after birth. All samples were analyzed for GBS using real-time PCR testing and culture methods. Capsular typing was performed for all GBS isolates and GBS-positive samples using real-time PCR testing.ResultsThe overall maternal and neonatal GBS-positivity rates were 22.7% (57/251) and 8.8% (22/251), respectively. IAP for GBS-positive mothers (96.5%) was highly administered. Eleven (19.3%) neonates born to GBS-positive mothers were GBS-positive, which was significantly higher than the 11 (5.7%) neonates born to GBS-negative mothers. The rate of GBS-positivity in neonates increased with an increased number of GBS colonies in mothers. More neonates were GBS-positive 1 month after birth than 1 week after birth, and there was a higher rate of GBS-positive rectal swabs than nasopharyngeal swabs. Capsular types of GBS that were isolated from each mother and neonate pair were the same, namely, Ib, III, V, and VI.ConclusionsThese findings indicate that the efficacy of IAP in preventing GBS transmission to neonates might be limited to within a few weeks after birth.     

Premature rupture of the membranes and sepsis in preterm neonates

This investigation was designed as a historical cohort study using data abstracted from medical records. Five hundred seven preterm neonates (26-35 weeks gestation) born alive from singleton pregnancies complicated by premature rupture of the membranes (PROM) were selected. Each neonate was matched on gestational age, gender, ethnicity, and date of delivery to a neonate without PROM. A matched pairs analysis was done using risk ratios (RR) to measure strength of the association and risk differences (RD) to measure absolute effect. Analysis revealed that preterm births complicated by PROM were at significantly higher risk of neonatal sepsis (RR = 3.5) and infection (RR = 2.4). The RDs indicated that PROM exposure contributed an excess of 5 cases of sepsis per 100 infants (RD = 0.05). PROM was not significantly associated with neonatal mortality, but when PROM had existed over 48 hours there was a higher risk of sepsis and infection. Birth of a neonate over 1500 grams or 33 weeks gestation was the most important factor in reducing risk of infection in PROM deliveries.     

GBS阳性孕妇阴道微生态与妊娠不良事件的相关性

目的 研究B族链球菌(GBS)阳性孕妇阴道微生态与不良妊娠事件间的相关性.方法 前瞻性选取2017年6月至2019年6月间于恩施州土家族苗族自治州中心医院行常规孕检并分娩的880例孕妇纳为研究对象,分别在孕早期(孕8～12周)及孕晚期(孕37周)使用胶体金免疫层析法行GBS检测.使用五联阴道试剂盒检测阴道微生态,同时记...     

Maternal colonisation with group B streptococcus and effectiveness of a culture-based protocol to prevent early-onset neonatal sepsis

This study was conducted to find out the group B streptococcus colonisation of pregnant women in Kocaeli, Turkey. A culture plus individualised high-risk-based antibiotic prophylaxis was compared with high-risk-based approach alone. The screening of women was performed via vaginal and anal cultures for group B streptococcus (GBS). The maternal GBS colonisation rate was found to be 6.5%. All colonised women or preterm labours with unavailable culture results until delivery received prophylactic antibiotics. Neonatal colonisation rate and early-onset neonatal sepsis due to GBS was 1/200. The unscreened 900 women received prophylactic antibiotics due to a risk factor-based approach. The neonatal colonisation rate was 17/900 (p = 0.1), and the rate of early-onset neonatal sepsis was 3/900 (p = 0.6). A culture plus individualised high-risk-based antibiotic prophylaxis provided an insignificant change in neonatal colonisation and early-onset neonatal sepsis with GBS when compared with high-risk-based approach alone.     

妊娠晚期B族链球菌感染对孕妇阴道清洁度及不良妊娠结局的影响

目的:探讨妊娠晚期阴道B族链球菌(group B Streptococcus,GBS)感染与阴道清洁度及不良妊娠结局的关系。方法:选择2012年6月至2014年8月在上海市嘉定区妇幼保健院产科检查及分娩的孕35周以上的孕妇共1 864例,常规进行阴道清洁度检测及GBS培养。比较阴道清洁度异常组与正常组孕妇GBS带菌率的情况。观察GBS(+)组与GBS(-)组孕妇胎膜早破、早产、产褥感染的发生情况。结果:1 864例中,GBS阳性率5.15%(96/1 864)。阴道清洁度正常孕妇1 057例,其中GBS阳性率3.60%(38/1 057);阴道清洁度异常孕妇807例,其中GBS阳性率7.19%(58/807),差异有统计学意义(P=0.001)。GBS感染孕妇胎膜早破与产褥感染的发生增加(P0.05),发生风险[比值比(odds ratio,OR)]分别增加13.40倍、2.20倍。结论:阴道清洁度异常者GBS带菌率更高;妊娠晚期GBS感染对围产期结局有不良影响,妊娠晚期应加强GBS检测。     

Vaginal bacterial flora of pregnant women colonized with group B streptococcus

 To elucidate the characteristics of group B streptococcus (GBS)-positive vaginal flora in pregnant women, vaginal cultures were conducted in 4025 women at 22 to 36 weeks of gestation. The results were analyzed by Fisher's exact test. Among 4025 women, 408 were found to be GBS positive and 3617 were GBS negative (GBS-negative group). A total of 1151 bacterial strains were recovered in the GBS-positive group and 6746 strains in the GBS-negative group. The percentages of Gram-positive cocci other than GBS, anaerobes, fungi, and Lactobacillus were 18.8%, 1.4%, 6.0%, and 34.4%, respectively, in the GBS-positive group, and 30.4%, 4.1%, 8.8%, and 53.5% in the GBS-negative group. The percentages were significantly lower in the GBS-positive group (P < 0.0001, P < 0.0001, P = 0.0012, P < 0.0001, respectively). Judging from the reduction in Lactobacillus, the GBS-positive vaginal flora is not considered a normal flora. However, it is not regarded as a pathogenic flora either, because the isolation rates of anaerobes (strongly associated with bacterial vaginosis) and fungi (occasionally causing vulvovaginal candidiasis) were lower than in the GBS-negative flora. These results suggest that the GBS-positive flora is associated with a lower risk of abnormality during pregnancy and abnormal pregnancy outcome compared with the GBS-negative flora, although this group is one of the most important pathogens in neonatal infections. Received: March 5, 2002 / Accepted: June 17, 2002     

孕晚期阴道及肛周拭子不同方法检测B族链球菌和真菌的效果评价及耐药分析

目的 探讨不同方法检测孕晚期孕妇生殖道B族链球菌(GBS)和真菌的效果评价,并对分离培养出的GBS进行耐药性分析,为临床提供有效的预防和治疗依据。方法 选择2013年1月～2017年12月西安高新医院产科门诊孕晚期孕妇22 938例,采集孕35～37周孕妇阴道拭子和肛周拭子标本,按照随机分组原则,采用血琼脂培养法、显色培养法及聚合酶链反应(PCR)3种方法进行GBS检测,同时用前两种培养法进行真菌检测,并对分离出的368株GBS进行药敏试验。结果 22 938例孕妇中,6 782例采用血琼脂培养,检出GBS 105例(阳性率1.5%),检出真菌665例(阳性率9.8%); 5 957例采用显色培养法,检出GBS 263例(阳性率4.4%),检出真菌72例(阳性率1.2%); 10 199例采用PCR法,检出281例阳性(阳性率2.8%)。分离出368株GBS经定量药敏实验,其对氨苄西林、青霉素、头孢吡肟、头孢噻肟、头孢曲松、利奈唑胺和万古霉素的敏感率均为100%; 对红霉素、克林霉素和左氧氟沙星的敏感率分别为17.9%,25.4%和66.7%。三种筛查GBS的方法比较,差异均有统计学意义(χ²=94.05,P<0.05),显色培养法的阳性率最高。两种培养方法对真菌的检测比较,差异有统计学意义(χ²=429.99,P<0.5),血琼脂培养法检出率较高。结论 显色培养法筛查GBS有望成为孕晚期孕妇检测GBS感染的一种首选方法,而血琼脂培养法则有利于对孕妇阴道真菌的检出,建议两种方法联合使用,以提高对GBS和真菌的检出率,减少因GBS和真菌引起的胎膜早破和新生儿感染。     

Update on group B streptococcal infections: perinatal and neonatal periods

Group B Streptococcus (GBS), one of the beta-Hemolytic streptococci, remains a leading cause of neonatal sepsis in the United States. The first consensus guidelines for the prevention of neonatal GBS disease were published in 1996, recommending intrapartum antibiotic prophylaxis on the basis of screening-based or risk-based strategies. Since then, there has been a 70% decrease in the rate of early-onset GBS disease. On the basis of evidence-validating superiority of this screening-based strategy, new national guidelines were released in 2002. Data from the Centers for Disease Control and Prevention in 2005 showed a continued decrease in the annual incidence of early-onset GBS infection. The screening-based strategy involves universal screening of all pregnant women at 35 to 37 weeks' gestation for vaginal and rectal GBS colonization and recommends intrapartum antibiotic prophylaxis for all GBS carriers (unless delivered by planned cesarean section before the onset of labor in a woman with intact membranes) with penicillin-G (or ampicillin). For mothers with severe penicillin allergy, clindamycin or erythromycin is recommended, when GBS' sensitivity is known; otherwise, vancomycin is recommended. Cefazolin is recommended for individuals with mild penicillin allergy. Severe anaphylactic reactions to penicillin were extremely rare. Emergence of antibiotic resistance to penicillin is still a theoretical possibility. This article provides a detailed account of recommendations for screening, diagnosing, and treating GBS disease in newborns.     

Prevention of group B streptococcal disease in the newborn

Group B streptococcus (GBS) is a leading cause of morbidity and mortality among newborns. Universal screening for GBS among women at 35 to 37 weeks of gestation is more effective than administration of intrapartum antibiotics based on risk factors. Lower vaginal and rectal cultures for GBS are collected at 35 to 37 weeks of gestation, and routine dindamycin and erythromycin susceptibility testing is performed in women allergic to penicillin. Women with GBS bacteriuria in the current pregnancy and those who previously delivered a GBS-septic newborn are not screened but automatically receive intrapartum antibiotics. Intrapartum chemoprophylaxis is selected based on maternal allergy history and susceptibility of GBS isolates. Intravenous penicillin G is the preferred antibiotic, with ampicillin as an alternative. Penicillin G should be administered at least four hours before delivery for maximum effectiveness. Cefazolin is recommended in women allergic to penicillin who are at low risk of anaphylaxis. Clindamycin and erythromycin are options for women at high risk for anaphylaxis, and vancomycin should be used in women allergic to penicillin and whose cultures indicate resistance to clindamycin and erytbromycin or when susceptibility is unknown. Asymptomatic neonates born to GBS-colonized mothers should be observed for at least 24 hours for signs of sepsis. Newborns who appear septic should have diagnostic work-up including blood culture followed by initiation of ampicillin and gentamicin. Studies indicate that intrapartum prophylaxis of GBS carriers and selective administration of antibiotics to newborns reduce neonatal GBS sepsis by as much as 80 to 95 percent.     

Improving perinatal Group B streptococcus screening with process indicators

Rationale Group B streptococcus (GBS) neonatal infection can be prevented by screening pregnant women for GBS colonization from the 34th to the 38th week of gestation, as has been recommended in France since 2001. We assessed guideline adherence among midwives and obstetricians. Methods From 2006 to 2008, new and mandatory GBS data were added to the obstetric database. We merged the latter with a bacteriological database and a paediatric database and defined process indicators for pregnant women who delivered from the 37th week of gestation in the hospital of Poitiers and for neonates hospitalized for a GBS infection from 2006 to 2008. Results We abstracted 5997 pregnant women (1942 in 2006, 1975 in 2007 and 2080 in 2008) and 84 neonates (17 in 2006, 32 in 2007 and 35 in 2008). GBS pregnancy colonization prevalence was 15%, 13% and 18% respectively. Availability of GBS screening status was stable (96%, P = 0.15). The rate of GBS screening during pregnancy increased significantly (86% to 90%, P = 0.002). Percentage of correct‐term screening increased significantly (89% to 96%, P < 0.001). Percentage of women who received intra‐partum antibiotic prophylaxis decreased significantly (84% to 70%, P = 0.001). Percentage of women who received correct intra‐partum antibiotic prophylaxis was stable (75%, P = 0.65). Percentage of neonates whose mother had been correctly screened but negative was 77%, 67% and 68% respectively (P = 0.61). Conclusion Our mandatory database entailed guideline adherence over a short lapse of time and resulted in a significant increase of the screening rate at the correct term. However, circumstances where neonates are infected still remain. Screening test performance needs to be re‐evaluated.     

孕晚期阴道B族链球菌定植的两种筛查方法比较

  目的  比较传统阴道拭子培养法和阴道直肠拭子Lim次代接种法对孕晚期阴道B族链球菌(group B streptococcus, GBS)定植的筛查效果。   方法  2014年12月至2015年8月在北京协和医院产科门诊接受常规产前检查的1371名孕妇, 于孕35~37周同时采取传统阴道拭子培养法和阴道直肠拭子Lim次代接种法筛查GBS, 采用卡方检验比较并分析两种筛查方法的阳性率、检出率和假阴性率。   结果   1371名孕晚期妇女阴道GBS的定植率为8.0%, 传统阴道拭子培养法的检出率为41.8%, 假阴性率为58.2%;阴道直肠拭子的检出率为80.0%, 假阴性率为20.0%;两种方法检出率差异具有统计学意义(P < 0.001)。   结论  阴道直肠拭子Lim次代接种法对阴道GBS定植筛查的效率优于阴道拭子培养法, 二者联合应用可提高检出率, 避免漏诊。     

Effects of water birth on maternal and neonatal outcomes.

BACKGROUND: Our purpose was to assess benefits and possible disadvantages of water births and to compare maternal and neonatal outcomes with normal vaginal deliveries. METHODS: This case-controlled study was carried out between January 2000 and July 2001. A total of 140 women who wanted water births were enrolled into the study. Our analysis was restricted to a sample of women with a gestational age > 37 weeks, a normal sized foetus, a reactive admission cardiotocography, drainage of clear amniotic fluid (if the membranes were already ruptured) and a pregnancy with cephalic presentation. Women with medical or obstetric risk factors were excluded. 140 controls were selected from the delivery database as the next parity-matched normal spontaneous vaginal delivery. RESULTS: A statistically significant lower rate of episiotomies (p = 0.0001) and vaginal trauma (p = 0.03) was detected in the group assigned to water birth, whereas the frequency of perineal tears and labial trauma remained similar in both groups (p > 0.05). A statistically significant decrease in the use of medical analgesia (p = 0.0001) and oxytocin (p = 0.002) was observed in women who had water births. A trend towards a reduction of the length of the first stage of labour was only observed in primiparous women bearing in water, but this reduction did not reach statistically significance (p > 0.05). Manual placenta removal (p = 0.017), severe postpartum haemorrhage (blood loss > 500 ml; p = 0.002) and maternal infection rate (p = 0.03) were statistically significant lower in women who delivered in water. When analysing the postpartum haemoglobin, no statistically significant differences could be observed between the two groups (p > 0.05). No statistically significant differences were detected for neonatal parameters (p > 0.05) between women who had had water births and those choosing conventional vaginal delivery.     

Comparison of culture and 2 real-time polymerase chain reaction assays to detect group B Streptococcus during antepartum screening

Group B Streptococcus (GBS) is the most common cause of life-threatening infection in neonates but is preventable if the mother is diagnosed before and treated at delivery. Using 200 vaginal-rectal swabs inoculated to enrichment (LIM) broths, we compared routine culture and 2 real-time polymerase chain reaction (PCR) assays for detection of GBS: the LightCycler (LC) Strep B analyte-specific reagents (ASRs) (Roche Diagnostics, Indianapolis, IN) and the BD GeneOhm StrepB (BD-StrepB) test (BD GeneOhm Sciences, San Diego, CA). Culture detected 26.5% GBS-positive specimens, whereas the LC Strep B ASR and BD-StrepB test identified 29.5% and 30.0% positive specimens, respectively. Because of the increased detection rate of 3.0% to 3.5% observed with PCR, a second GBS-specific amplicon was sequenced to confirm the presence of GBS that was not detected by culture. In our hands, the sensitivity/specificity of the LC Strep B ASR was 100%/95.9%, and the BD-StrepB test was 92.5%/92.5% using culture as the gold standard.     

A case of facial cellulitis caused by group B streptococcus in an extremely low birthweight infant

Group B streptococcus (GBS) is an important pathogen that causes neonatal sepsis and meningitis, which have high mortality and morbidity. Cellulitis is a rare presentation of late-onset neonatal GBS infection. We report the case of an extremely low birthweight infant with facial cellulitis caused by late-onset GBS infection. A 590-g male neonate was delivered by Cesarean section at 23 gestational weeks due to intrauterine GBS infection. Although he was effectively treated with 2 weeks of antimicrobial therapy for early-onset GBS sepsis, he subsequently developed facial and submandibular cellulitis caused by GBS at 44 days of age. He was treated with debridement and antibiotic therapy, and after 2 months his facial involvement had improved, but cosmetic issues remained. Neonatal GBS infection requires a prompt sepsis workup followed by the initiation of empiric antibiotic therapy. Additionally, lifesaving surgical debridement is sometimes necessary for cellulitis, even in premature infants.     

Preliminary evaluation of Hitchens-Pike-Todd-Hewitt medium (HPTH) for detection of Group B Streptococci in pregnant women

We aimed to compare Hitchens-Pike-Todd-Hewitt (HPTH) enrichment broth, Todd-Hewitt broth, and direct culture onto blood sheep agar containing selective antimicrobial (ABA) in screening Group B Streptococci (GBS) carriage in pregnant women. From April to June 2007, duplicate lower vaginal and duplicate anorectal specimens of 102 pregnant women at 35 weeks of gestation or more, who were assisted at Santa Casa de Misericórdia Hospital, Maringá, Paraná, Brazil, were screened by GBS using HPTH, Todd-Hewitt broth, and ABA. Twenty-five (24.5%) pregnant women had one or more positive culture for GBS in those media. The positive rate for each medium was 21.6% (22/102) in the HPTH, 12.8% (13/102) in ABA, and 11.8% (12/102) in Todd-Hewitt broth. HPTH seems to be a high satisfactory medium for screening GBS in vaginal and anorectal samples in pregnant women and additional studies would be interesting in a larger number of pregnant women and in different laboratories.     

High rates of perinatal group B Streptococcus clindamycin and erythromycin resistance in an upstate New York hospital

The objective of this study was to evaluate the rates of clindamycin and erythromycin resistance among group B Streptococcus (GBS)-positive isolates cultured from pregnant women in an upstate New York community hospital. All GBS-positive perinatal rectovaginal cultures obtained from January 2010 through October 2011 were tested for resistance to erythromycin and clindamycin. Among the 688 GBS-positive cultures, clindamycin resistance was found in 38.4% and erythromycin resistance was found in 50.7%. Rates of GBS resistance to clindamycin and erythromycin are much higher than reported in earlier U.S. studies, suggesting both increasing resistance and regional variation in resistance. These findings lend strong support to the CDC and American College of Obstetricians and Gynecologists (ACOG) recommendations that clindamycin use for intrapartum antibiotic prophylaxis be restricted to penicillin-allergic women at high risk of anaphylaxis and that GBS isolates be tested for antibiotic resistance prior to the use of clindamycin in these women.     

超高龄孕妇终止妊娠时机探讨

目的探讨超高龄孕妇终止妊娠时机对母婴结局的影响。 方法回顾性分析佛山市第一人民医院产科2016年2月至2019年1月160例超高龄孕妇分娩的资料,依据产妇分娩时妊娠周数分为超预产期妊娠组（40~41周,共33例）和正常足月妊娠组（37~39^＋6周,共127例）。对两组患者的年龄、距离前次妊娠时间、分娩前血红蛋白水平、产时体质量指数（BMI）等指标的组间比较采用t检验,对两组患者直接剖宫产、阴道试产失败后转剖宫产、阴道助产、顺产、产后出血、新生儿转儿科、羊水过少、羊水混浊、急性胎儿窘迫、胎膜早破、巨大儿的发生率的组间比较采用χ²检验。 结果超预产期妊娠组与正常足月妊娠组在年龄、距离前次妊娠时间、分娩前血红蛋白水平、产时BMI、直接剖宫产率、阴道试产失败后转剖宫产率、阴道助产率、顺产率、产后出血发生率、新生儿转儿科发生率、胎膜早破发生率、巨大儿发生率等方面差异无统计学意义（P均>0.05）。超预产期妊娠组与正常足月妊娠组比较,羊水过少发生率（15.15% vs 3.15%,χ²=5.026,P=0.025）、羊水混浊发生率（33.33% vs 3.15%,χ²=24.648,P<0.001）、急性胎儿窘迫发生率（12.12% vs 1.57%,χ²=5.414,P=0.020）均明显增高,差异有统计学意义。 结论超高龄孕妇应选择足月后预产期前终止妊娠,降低发生围产儿不良结局的概率。     

Removal of group B streptococci colonizing the vagina and oropharynx of mice with a bacteriophage lytic enzyme

Group B streptococci (GBS) are the leading cause of neonatal meningitis and sepsis worldwide. The current treatment strategy is limited to intrapartum antibiotic prophylaxis in pregnant women to prevent early-onset neonatal diseases, but considering the potential for antibiotic resistance, the risk of losing control over the disease is high. To approach this problem, we have developed a bacteriophage (phage) lytic enzyme to remove colonizing GBS. Bacteriophage muralytic enzymes, termed lysins, are highly evolved molecules designed to degrade the cell wall of host bacteria to release phage particles from the bacterial cytoplasm. Several different lysins have been developed to specifically kill bacterial pathogens both on mucosal surfaces and in blood and represent a novel approach to control infection. A lysin cloned from a phage infecting GBS was found to contain two putative catalytic domains and one putative binding domain, which is similar to the domain organization of some staphylococcal phage lysins. The lysin (named PlyGBS) was recombinantly expressed in Escherichia coli, and purified PlyGBS efficiently killed all tested GBS serotypes in vitro. In a mouse model, a single dose of PlyGBS significantly reduced bacterial colonization in both the vagina and oropharynx. As an alternative strategy for intrapartum antibiotic prophylaxis, this approach may be used to reduce vaginal GBS colonization in pregnant women before delivery or to decontaminate newborns, thus reducing the incidence of GBS-associated neonatal meningitis and sepsis.     

In vitro antimicrobial activity of benzalkonium chloride against clinical isolates of Streptococcus agalactiae

OBJECTIVES: Despite antibiotic prophylaxis for at-risk mothers during labour and delivery, Streptococcus agalactiae (group B Streptococcus; GBS) still causes substantial morbidity and mortality among newborns. In addition to the well-known side effects of the administration of antibiotics, resistance to drugs recommended for penicillin-allergic pregnant women, such as erythromycin and clindamycin, has increased, thus raising concern about the possibility of inadequate prophylaxis. On this basis we evaluated the antimicrobial activity of benzalkonium chloride against GBS, which has been described as an antimicrobial agent for the topical treatment of vaginal infections. METHODS: A total of 52 GBS from pregnant women have been studied. The capacity of benzalkonium chloride as well as of penicillin, erythromycin, clindamycin, vancomycin, chloramphenicol and tetracycline to inhibit GBS was evaluated using broth macrodilution and microdilution methods, respectively. RESULTS: While all the strains were penicillin- and vancomycin-susceptible, 19.2% were resistant to both erythromycin and clindamycin. In contrast, all GBS isolates were either inhibited or killed by benzalkonium chloride at not only low but also very similar concentrations (MIC90 = 3.12 mg/L). CONCLUSIONS: Benzalkonium chloride might represent an alternative strategy that is useful in reducing vaginal GBS colonization in pregnant women before delivery by topical treatment.     

Reference ranges of presepsin (soluble CD14 subtype) in term and preterm neonates without infection,in relation to gestational and postnatal age,in the first 28 days of life

ObjectiveTo determine the reference ranges of presepsin in term and preterm neonates without infection, with respect to gestational and postnatal age, within the first 28 days of life.MethodsA total of 144 neonates born at 24–42 weeks’ gestation, including healthy term and preterm neonates without clinical signs or symptoms of infection, were included in this prospective observational study. Presepsin measurements included cord blood levels and serum levels on postnatal days 1, 3, 5, 7, 14, 21, and 28.ResultsThe presepsin values corresponding to the 10th percentile ranged from 240.8 pg/mL (on day 1) to 129.9 pg/mL (on day 28), whereas those corresponding to the 90th percentile ranged from 725.8 pg/mL (on day 1) to 471.6 pg/mL (on day 28). Significantly higher presepsin levels were observed in cesarean deliveries than in spontaneous deliveries (p: 0.012 to <0.001), in gestational ages ≤ 32 weeks than in gestational ages ≥37 weeks (p: <0.05 to <0.001), and in cases with a maternal history of chorioamnionitis than in those without (p: <0.05 to <0.001).ConclusionIn conclusion, our findings revealed, for the first time, the reference ranges of presepsin in healthy term and preterm neonates without infection with respect to gestational and postnatal age, sex, and body weight. Presepsin levels within the first 28 days of life seem likely to be affected by the type of delivery, gestational and postnatal age, birth weight, and presence of respiratory distress syndrome or maternal chorioamnionitis.