DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20163671

The evaluation of C-reactive protein as a screening tool for neonatal sepsis

Ramaning Loni, Aoyon Sengupta, Geetha Jaganathan, Praveen Kumar Singh

Abstract


Background:Bacterial sepsis and meningitis continues to be major causes of neonatal mortality and morbidity in low birth weight infants. C - reactive protein (CRP) is a simple investigation which has diagnostic potential but the previous studies have yielded variable results. A combination of screening tests along with the clinical signs is useful to diagnose/rule out neonatal sepsis along with gold standard blood culture. The objective was to study CRP in relation to other haematological parameters in diagnosis of sepsis and to find out whether CRP estimation helps in early treatment interventions like stopping empirical antibiotic therapy in neonatal sepsis.

Methods: A prospective study of 62 neonates with suspected sepsis admitted in level 2 neonatal special care unit of TMH, Jamshedpur from 1st January 2010 to 30th September 2010 were evaluated after meeting inclusion criteria using clinical criteria, sepsis screen and blood culture, which was taken as gold standard for diagnosis of neonatal sepsis.

Results:Total blood culture positive cases were 26 (42%) and  CRP was positive in total 24 cases (39%) of total 62 cases, of which, it  is increased in 19 cases (79%) of total 26 culture proven cases and in 5 cases (21%) of culture negative cases. The CRP was increased in 14 cases (35%) out of total 40 cases in early onset sepsis (EOS) group as compared to 10 cases (45.5%) out of 22 in late onset group. The sensitivity of CRP is more in late onset sepsis (LOS) (45.5%) than in early onset sepsis (35%). CRP rise was highest with 73% in proven sepsis, where as it is 23% and 8% in probable and no sepsis groups respectively. The CRP in present study is having sensitivity of test: 73%, specificity of test: 86.1%. The PPV and NPV were 79.1 and 81.6% respectively. If CRP is added to septic screen, it has improved the specificity of the test. Whereas, sepsis screen has sensitivity of 88.5%, the specificity of 83.3%, PPV 79.3% and NPV 90.9%. So, totally empirical antibiotic therapy was stopped in 23 cases of “no sepsis” group including both early as well as late onset sepsis.

Conclusions:Based on the result of our study, the CRP is an effective parameter for the diagnosis of neonatal sepsis and when used in conjunction with the sepsis screen, which increases the sensitivity and specificity of the test, it can help identify septic neonates and help in appropriate management while also reducing the unnecessary use of antibiotics, thereby helping curb the growing menace of antibiotic resistance.  

 


Keywords


CRP, EOS, LOS

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References


Puopolo, Karen M. Bacterial and fungal infections. In:Cloherty JP, Eichenwald EC, Stark AR editors. Manual of neonatal care.6th ed. Philadelphia: Wolters Kluwer, Lippincott Williams and Wilkins; 2008:274-300.

Khatua SP, Das AK, Chatterjee BD, Khatua S, Ghose B, Saha A. Neonatal septicemia. Indian J Pedaitr. 1986;53:503-14.

Grover RV, Sutherland JH. Purulent meningitis of new born infants. New Eng J Med. 1961;264:1115.

Stoll BJ. Infection of the neonatal infants. In: Nelson Textbook of Pediatrics. 18th edition Philadelphia: Saunders Elsevier; 2008:794-809.

Namdeo UK, Singh HR, Rajput VJ, Khushwaha JS. Hematological indices in early diagnosis of neonatal sepsis. Indian Pediatr. 1985;22:287.

Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. J Pediatr. 1979;95:89-98.

Paul VK, Singh M. Diagnosis and treatment of neonatal sepsis. Indian Pediatr. 1986;23(12):1023-35.

Sharma A, Krishna CV, Sabharwal U, Rathi S, Mohan H. Diagnostic and prognostic role of CRP and m-ESR in neonatal septicemia. Indian Pediatr. 1993;30:347-50.

Singh M, Narang A, Bhakoo ON. Evaluation of sepsis screen in diagnosis of neonatal sepsis. Indian Pediatr. 1987;24:39-43.

Alistair GS, Hewitt JR. Early diagnosis of neonatal sepsis. Indian Pediatr. 1980;65(5):1036-41.

Nuntnarumit P, Pinkaew O, Kitiwanwanich S. Predictive values of serial C-reactive protein in neonatal sepsis. J Med Assoc Thai. 2002;85(4):1151-8.

Ehl S, Gering B, Bartmann P, Hogel J, Pohlandt F. C-reactive protein is a useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection. Pediatrics. 1997;99(2):216-21.

Hajiehe B, Sedigheh B. Value of laboratory tests and CRP the detection of Neonatal sepsis. Inernet J Pedia Neonatology. 2005;5:2.

Zwaini EJ. C-reactive protein: a useful marker for guiding duration of antibiotic therapy in suspected neonatal septicaemia? Eastern Mediterranean Health J. 2009;15(2):269-75.

Bhandari B, Tak SK, Gupta KS, S Ramakrishnan. Evaluation of a sepsis screen for neonates. Indian Pediatr. 1988;25:860-2.

Desai N. Evaluation of laboratory parameters in early diagnosis of neonatal septicemia with special reference to the C-reactive protein. New Delhi: All India institute of Medical Science; 1984.

Rodwell RL, Leslie AL, Tudehope DT. Early diagnosis of neonatal sepsis using a hematological scoring system. J Pediatr. 1988;112:761-6.