199 Diagnostic Prediction Of Maternal Inflammatory Markers For Neonatal Sepsis

Abstract

Background: Elevated concentration of C-reactive protein(CRP) in the maternal blood is associated with the presence of intrauterine infection. Newborns born of mothers with perinatal infection, whether indicated as chorioamnionitis or positive CRP, have been associated with probable sepsis in early neonatal period. We purport this study to evaluate the diagnostic performance of maternal inflammatory markers, CRP and chorioamnionitis for prediction of neonatal sepsis.Methods: 126 low birth weight newborns(gestation 32±3.2wk, birth weight 1887±623g) and their mothers were recruited. Neonates were divided into sepsis group(65 infants) including both definite(positive blood culture) and probable(negative blood culture but with more than 3 abnormal clinical symptoms) episodes and control(61 infants). Mothers were grouped into histologic chorioamnionitis(n=27), clinical chorioamnionitis(n=18), other infection(n=12), and control(n=69). Mothers were subgrouped into CRP positive(n=32) and CRP negative group(n=94) by CRP 1.86 mg/dL, and calculated relative risk for neonatal sepsis according to maternal condition.Results: Maternal CRP was significantly higher in neonatal sepsis group than in control (2.18±2.79 vs. 1.09±1.29mg/ dl, p=0.0055). Maternal CRP(cutoff value 1.86 mg/dL) had sensitivity 74% and specificity 34% for predicting neonatal sepsis. Maternal CRP positive group had more neonatal sepsis than CRP negative group(69% vs46%, p=0.0245). Relative risk of neonatal sepsis in maternal CRP positive group was 2.61 times(95% CI:1.114– 6.106, p=0.027)) as high as CRP negative group. As maternal CRP increases continuously, the risk for neonatal sepsis increases as 1.31 times(95% CI:1.059–1.626, p=0.013). The relative risk of histologic chorioamnionitis was 2.57, clinical chorioamnionitis 1.21, and other infection 2 for neonatal sepsis, but not significant.Conclusion: The risk of neonatal sepsis significantly increases in the case of positive maternal CRP (more than 1.86 mg/dL). We suggest that maternal CRP should be considered as a risk factor for early neonatal sepsis.