miRNAs: novel noninvasive biomarkers as diagnostic and prognostic tools in neonatal sepsis

Abstract

Neonatal sepsis is known as a clinical syndrome that is character- ized by signs or symptoms of infection within the first 28 days fol- lowing delivery, and it can be confirmed by the isolation of the causative pathogen from the blood [1,2]. It is divided into 2 catego- ries: early-onset (within the first 72 hours from presentation) and late-onset (>72 hours) [3,4]. Based on a recent global estimate from over 14 countries, neonatal sepsis occurred in 29,608 cases out of 2,797,879 live births over a 10-year period (2009−2018), with an incidence of 3930 cases per 100,000 live births. It is also associated with a considerably high mortality rate of 17.6% (ranging from 10.3%−28.6%) worldwide [5]. Many risk factors are contributed to high mortality in neonates with sepsis, including lower Apgar scores, septic shock, mechanical ventilation, umbilical catheterization, neu- tropenia, severe thrombocytopenia, and carbapenem-resistant microorganisms [6] Due to the presentation of nonspecific signs and symptoms of infection, the diagnosis of neonatal sepsis poses a challenge to health- care practitioners [7,8], which further affects how quickly the treat- ment plan is initiated and the prognosis in this patient population [9]. Therefore, to minimize the risk of negative outcomes (namely progression or mortality), researchers have suggested the use of “bio- markers” that would help in the diagnosis of sepsis [9,10]. Based on the definition provided by the National Institute of Health (NIH), bio- markers are considered “indicators” that can be objectively measured to either indicate the presence of a disease or identify the response to a certain therapeutic drug. In the case of neonatal sepsis, both procal- citonin and C-reactive protein (CRP) are frequently investigated bio- markers; however, they are associated with limited diagnostic value [11]. To overcome those limitations, the introduction of novel