Abstract
Objective:To evaluate the adequacy of serum C-reactive protein (CRP) in diagnosing neonatal sepsis and role of CRP in determining the duration of antibiotic treatment in neonatal sepsis.Methods:In this validation study, we included 135 neonates with suspected diagnosis of sepsis within duration of nine months from September 2016 to May2017 in Children Hospital Multan. Blood samples were drawn from every neonate for culture sensitivity and measurement of serum C-reactive proteins. In all suspected neonates, empirical antibiotics e.g. Gentamycin or Ampicillin were started after taking blood samples. Serum CRP levels >5 mg/dl were marked as positive results. 2nd blood samples for measurement of serum CRP were taken after 72 hours of the first sample. There were two primary endpoints; one to determine the sensitivity and specificity of CRP against blood culture and second was to determine the negative predictive value of CRP in determining the duration of anti-biotic in neonates presenting with sepsis.Results:Out of these 135 babies, 102 (75.5%) were confirmed to have sepsis using blood culture reports. CRP results were Positive in 85 (62.9%) neonates on first baseline measurement and were positive in 103 (76.29%) neonates after 72 hours of admission. The sensitivity of CRP in diagnosing sepsis was 98.03%, specificity was 91.0%, positive predictive value (PPV) was 97% and negative predictive value (NPV) was 93.7%. The mean duration of antibiotic treatment in CRP guided group was 5.03 days versus 7.02 days in standard treatment duration group (p-value <0.001). The NPV of CRP in determining the duration of antibiotics was 100.0%.Conclusion:Serum CRP level is a reliable test in establishing the diagnosis of neonatal sepsis. It accurately monitors the duration of antibiotic therapy and results in significant reduction in the treatment duration of neonatal sepsis.
Highlights
Neonatal sepsis (NS) is a very challenging scenario for the neonatologists, because most of these neonates present with atypical symptoms and most of these mimic with non-infectious causes, making the exact and timely diagnosis very challenging.[1,2] Any invasive bacterial infection occurring within first month of life is defined as neonatal sepsis, it of early onset if occurs within first week of life and late onset if occurs in after first week of one month.[3]
We evaluated the adequacy of serum C-reactive protein (CRP) in diagnosing neonatal sepsis and their role in determining the duration of antibiotic treatment in neonates presenting with suspicion of septicemia
Among the various hematological factors studied for the early diagnosis of sepsis, CRP is one of them and is most widely studied
Summary
Neonatal sepsis (NS) is a very challenging scenario for the neonatologists, because most of these neonates present with atypical symptoms and most of these mimic with non-infectious causes, making the exact and timely diagnosis very challenging.[1,2] Any invasive bacterial infection occurring within first month of life is defined as neonatal sepsis, it of early onset if occurs within first week of life and late onset if occurs in after first week of one month.[3] Prevalence rate of NS has been reported to be 10/1000 to 15/1000 live births in developed world and 15/1000 to 25/1000 live births in South Asia.[1,4]. Pak J Med Sci November - December 2017 Vol 33 No 6 www.pjms.com.pk 1434. The current recommendation is to treat septic neonates for 48 to 72 hours if blood culture reports are negative and for 7 to 14 days if culture report is positive.[6,7] According to different studies, about 11% to 23% neonates are treated wrongly for sepsis but they are not having it.[6,7,8] This results in anti-biotic resistance, it has many other short-term complications (e.g. pain and infection) and some long term complications (e.g. hearing disorder and necrotizing enterocolitis).[9,10]
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