Procalcitonin and diagnosis of neonatal sepsis: moving on

To interpret correctly the results of procalcitonin (PCT) accuracy studies for the diagnosis of neonatal sepsis, it is time to begin to debate the methods we use to measure PCT performance, rather than just how PCT performs. Therefore we should move toward the better use of the information available including criteria to: (1) substantiate (or rule-out) the diagnosis of neonatal sepsis; (2) define the normal(and abnormal) upper limits of PCT; (3) identify which prenatal, perinatal and neonatal variables are in play in modulating host characteristics and PCT response in the healthy, uninfected and infected neonate, respectively; and (4) evaluate the quality of reporting of PCT accuracy studies for diagnosing neonatal sepsis in terms of internal (risk of bias) and external (generalizability) validity of the results.