GRANULOCYTE ELASTASE DETERMINATION IN COR D-BLOOD OF NEONATES AT RISKFOR MATERNOFETAL INFECTION

Background. - Polymorphonouclear elastase is an early and sensitive in dicator of neonatal infection when performed at the beginning of clini cal symptoms. Patients and methods. - To investigate the diagnostic va lue of elastase measurement in cord blood immediately after birth. 211 neonates (103 boys vs 108 girls, 154 vaginal delivery vs 57 cesarean section). Mean gestational age 38.9 weeks (range: 30-42), mean birth w eight 3,260 g (range: 1,430-4,920 g). After clinical, bacterial and bi ological screening, the infants were classified in three groups. Group A (n = 118): non infectious risk factor neither clinical signs of inf ection; group B (n = 79): one or more risk factors but no evidence of infection; group C (n = 14): proved or probable infection. Polymorphon uclear elastase was measured in cord blood of all infants using an het erogenous enzyme-linked-immunosorbent assay. Results. - We observed hi gher elastase values in group C (176 +/- 67 mu g/L) than in group A (9 1 +/- 64 mu g/L) and B (67 +/- 61 mu g/L) (mean +/- SD, P = 0.0001). W ith a cutoff value fixed at 80 mu g/L, the sensitivity of this test ap plicated to neonates presenting materno-fetal infectious risk factor(s ) was 85% (12/14), specificity 74% (59/79), positive predictive value 37%, and negative predictive value 96%. Conclusion. - Because two of t he 14 infected infants (15%) were not detected by elastase dosage in c ord blood, this test cannot be used as an early indicator of materno-f etal infection.