Pentraxin-3 and neonatal sepsis: a systematic review and meta-analysis

Figures & data

Figure 1. PRISMA flow diagram. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

Table 1. Study characteristics of the included studies.

Author, year	Country of origin	Study design	Inclusion criteria	Type of sepsis	Pentraxin levels (μg/L)	Exclusion criteria	Assay	NOS scale rating	Cutoff(μg/L)
Battal et al., 2019	Turkey	Case-control	Antenatal history of (A) maternal fever of at least 38 °C or the presence of chorioamnionitis with two of the following criteria: leukocytosis (above 15,000/mm^3), maternal tachycardia (above 100 beats/min), fetal tachycardia (over 160 beats/min), uterus sensitivity and/or bad smelling amniotic fluid; (B) premature rupture of membranes longer than 18 hours; and (C) maternal colonization with GBS (group B Streptococcus) or the presence of clinical signs of sepsis, such as hypo/hyperthermia, feed intolerance, lethargy, hypotonia, irregular cardiac rhythms, bradycardia, cyanosis, apnea, respiratory distress, or metabolic acidosis	Early onset neonatal sepsis	2.273 ± 1.26	Premature neonates	Bosterbiotech. Co. Ltd., Pleaseanton, CA, United States	****	NA
Fahmey et al., 2019	Egypt	Case-control	Positive blood culture in newborn with clinical and laboratory findings of infection. Clinical signs include temperature instability, hypotension, prolonged capillary refilling time, tachycardia or bradycardia, apnea, respiratory distress, irritability, lethargy, seizures, poor feeding, vomiting, abdominal distention, jaundice, petechiae and bleeding	Late onset neonatal sepsis	28.98 ± 9.04	Congenital anomalies, acute renal injury and those exposed to perinatal asphyxia	Cusabio Biotech Co., 108 Ltd., China).	******	5.6
Sabry et al., 2021	Egypt	Case-control	Clinical, laboratory and positive blood culture results. The clinical findings included the presence of three or more of the following: temperature instability, respiratory alterations, cardiovascular alterations, neurologic alterations, gastrointestinal alterations. CRP values > 6mg/L were considered to be positive	Early onset neonatal sepsis	5.2 ± 3.7	Preterm neonates and neonates with suspected metabolic disease	Adipo Bioscience, CA, USA	****	NA
Tunc et al., 2019	Turkey	Cohort	Clinical sepsis: Being at the postnatal age of ≤72 hours and presenting with 111 nonspecific findings of sepsis such as apnea, needing supplemental oxygen or mechanical ventilation hypotension, bradycardia or tachycardia, temperature instability, feeding intolerance, abdominal distension, and necrotizing enterocolitis. Proven sepsis was defined as any newborn with a positive blood culture.	Early onset neonatal sepsis	1.98 ± 3.37	Newborns with congenital abnormalities	NA	*****	NA
Baumert et al., 2021	Poland	Case-control	Clinical manifestation (poor suckling, lethargy, altered muscle tone, respiratory distress, apnea, poor perfusion, cyanosis, bradycardia, thermoregulatory disorders including fever or hypothermia, food intolerance, and metabolic acidosis) and laboratory test results (blood culture for aerobic/anaerobic bacteria, CRP, PCT, platelet count, and white blood cell (WBC) count) were necessary for inclusion		8.4558 [6.3392–10.5725]	Non-causasian neonates and delivered only with cesarean section.	BioVendor; Brno, Czech Republic).	*****	8.5

Table 2. Patient characteristics of the included studies.

Study	Septic newborns					Healthy newborns
	Sample size (N)	Male gender	Weight (g)	Vaginal birth	Gestational age (weeks)	Sample size (N)	Male gender	Weight (g)	Vaginal birth	Gestational age (weeks)
Battal et al., 2019	30	17	ΝΑ	ΝΑ	ΝΑ	28	15	ΝΑ	ΝΑ	ΝΑ
Fahmey et al., 2019	60	34	2860 ± 598	11	35.77 ± 2.37	30	16	2868 ± 478	7	35.6 ± 2.03
Sabry et al., 2021	35	18	NA	19	NA	35	17	NA	3	NA
Tunc et al., 2019	36	25	NA	8	33,91 ± 4,88	41	21	NA	13	34.09 ± 4.83
Baumert et al., 2021	29	19	2570 [2240–2970]	0	37 [35–38]	47	25	2605 [2350–3020]	0	37 [36–39]

Figure 2. Forest plot of the overall outcome and all subgroups.

Table 3. Leave-one-out meta-analysis.

Study omitted	Mean difference (MD)	95% Confidence intervals (CI)	p-Value	τ ^2	τ	I^2 (%)
Battal et al., 2019	9.8612	[−2.2001; 21.9225]	.1091	112.8611	10.6236	99.5
Fahmey et al., 2019	1.6062	[0.5647; 2.6477]	.0025	0.5838	0.7641	69.8
Sabry et al., 2021	9.3022	[−0.9650; 19.5694]	.0758	81.6973	9.0387	99.5
Tunc et al., 2019	10.0206	[0.1036; 19.9375]	.0477	76.1891	8.7286	99.5s

Figure 3. Funnel plot: (a) overall outcome, (b) early onset neonatal sepsis subgroup.