C-Reactive Protein in Neonatal Sepsis

Abstract

SEPSIS IS ONE OF THE MOST COMMON diagnostic challenges in the NICU. Currently a definitive diagnosis can be made only with the gold-standard blood culture, which is generally not available for 48 hours.1,2 Difficulty obtaining a large enough sample to detect a positive blood culture, as well as increased use of antenatal antibiotics, has complicated the ability to make a definitive diagnosis of sepsis.3 If left untreated, sepsis can increase morbidity and mortality. Therefore, many infants are treated empirically with broad-spectrum antibiotics.4,5 Two kinds of tests would be most helpful in the diagnosis of neonatal sepsis: one that quickly confirms the diagnosis and one that conclusively rules it out. In fact, a diagnostic sepsis marker with a high negative predictive value (the value representing patients without sepsis who are correctly diagnosed) might reduce the short- and long-term adverse effects of antibiotics, health care costs, and length of hospital stay.6 Despite extensive investigation no single test meets the criteria that would make it an ideal marker for the early diagnosis of sepsis in the newborn.5,7,8 Generally, screening includes a complete blood count with differential and may be accompanied by other adjunctive tests such as a C-reactive protein (CRP).9–11 This column examines CRP, an acute phase reactant (APR), as a diagnostic marker for neonatal sepsis.

Challenging the 48‐Hour Rule‐Out for Central Line–Associated Bloodstream Infections in the Pediatric Intestinal Failure Population

“…Elevation in CRP was a more sensitive indicator in our study, consistent with the findings from Robinson et al 40 However, CRP can take up to 24 hours after the onset of an infection to become elevated and has been suggested to have little utility in assisting in the early detection of sepsis 30 . In general, it has been used to serve as a surrogate marker of successful eradication of infection as the CRP level returns to normal with treatment of infection 41 . While sudden glucose intolerance and elevation of bilirubin and/or CRP levels have been suggestive of sepsis, our study did not identify these factors as a potential predictor for CLABSI.…”

Usefulness of the delta neutrophil index for assessing neonatal sepsis

“…Additionally, CRP is a well‐studied acute phase reactant, which is more helpful in guiding duration of antibiotic therapy than in making the diagnosis of sepsis. Tests for CRP levels are best used in late onset sepsis, as this test requires serial measurements to establish adequate sensitivity and specificity . Various cytokines including IL‐6, IL‐8 and CD64 have been assessed for use in the diagnosis of neonatal sepsis, but potential widespread use is limited by their inconsistent cut‐off values, delays in obtaining laboratory results, and lack of availability for routine measurements in clinical laboratories .…”

Apoptotic Changes in the Early Diagnosis and Severity Determination of Neonatal Sepsis

“…The hematological scoring system (HSS) can be used either singly or in combinations as an early indicator for a diagnosis of neonatal sepsis (3). CRP levels usually begin to rise within 4 -6 hours of the onset of sepsis, with peak levels reached within 48 -72 hours and remaining elevated until resolution of the inflammatory process (4).…”