Diagnostic Use of C-Reactive Protein (CRP) in Assessment of Neonatal Sepsis

Weitkamp, Jörn-Hendrik; Aschner, Judy L.

doi:10.1542/neo.6-11-e508

Cited by 36 publications

(35 citation statements)

References 16 publications

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“…Reliability of culture results may be limited in neonates by low sampling volume for blood [1], by sampling method for urine, and by administration of antibiotics before cultures are obtained for cerebrospinal fluid. Use of biomarkers to aid in detection of true sepsis has been extensively studied [10], with C-reactive protein (CRP) remaining the most widely used acute phase reactant [11]. The drawback of biomarkers as currently used is that they can be elevated in non-specific inflammatory processes, are not continuously available and are generally tested only after the infant develops concerning signs and symptoms, which, in some cases, may be too late.…”

Section: Conventional Approach To Sepsis and Nec Detectionmentioning

confidence: 99%

Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock

Sullivan

Fairchild

2015

Seminars in Fetal and Neonatal Medicine

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Section: Conventional Approach To Sepsis and Nec Detectionmentioning

confidence: 99%

Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock

Sullivan

Fairchild

2015

Seminars in Fetal and Neonatal Medicine

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“…5 c-reactIve proteIn C-reactive protein was first described by Tillet and francis in 1930. 1,6,9 It was named for its ability to bind with the C polysaccharide of Streptococcus pneumoniae. 8 C-reactive protein is a serum glycoprotein produced by the liver during acute inflammation or infection.…”

mentioning

confidence: 99%

“…1,3 The exact function of CRP is not known. 1,6 It has been suggested that its primary function is to act as an opsonin, binding and facilitating clearance of potentially toxic foreign or altered materials released from invading organisms or damaged tissues. The roles of CRP in activation of the complement pathway, promotion of phagocytosis, regulation of lymphocyte function, and platelet activation are under investigation.…”

mentioning

confidence: 99%

“…8 It appears, though, that CRP plays an important role in the first line of host defense. 6 C-reactive protein rises due to the increase in Interleukin-6 (IL-6), which is produced by macrophages, endothelial cells, T cells, and adipocytes. 13 C-reactive protein levels begin to rise within 4 to 6 hours (figure 1), usually becoming abnormal within 24 hours of the onset of infection.…”

mentioning

confidence: 99%

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C-Reactive Protein in Neonatal Sepsis

Hawk

2008

Neonatal Network

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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.

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“…Newborns generally have a physiological induction of inflammation values in the first few days after birth, and a moderate elevation of acute-phase reactants does not necessarily indicates sepsis. Cut-off levels of CRP vary among authors from 5 to 50mg/l [10][11][12][13][14]. CRP increases in 4-6h after an inflammatory trigger and peaks around 36-50h.…”

Section: Introductionmentioning

confidence: 99%

Targeting Asymptomatic Term and Late Preterm Newborns at Risk for Early Sepsis: C Reactive Protein 20mg/L Threshold

Ejarque-Albuquerque¹,

Oliveira²,

Santos³

et al. 2012

TOPEDJ

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Abstract:Identification of sepsis is a major issue due to limitations in diagnosis and severity of outcome. Different combinations of tests are used to screen babies at risk for infection, none specific enough to avoid treatment of noninfected newborns. 193 newborns with 35 weeks of gestational age admitted in the maternity were screened for infection using a protocol scoring system involving haematological values and CRP 10mg/l. Blood-cultures were taken after treatment decision, before antibiotics were started. No microbiological exam was included in the screening. Treatment decisions were taken by the staff irrespectively of the ongoing observational study.Newborns were classified by the authors in 4 groups: infected (culture verified), strongly suspected infection (SSI), no sepsis but treated (NST), no sepsis-no treatment (NSNT). Treatment decision was revaluated by the authors according to different cut-off levels of CRP.40 newborns (20.7%) received antibiotics. 2 had positive blood-cultures. 13 were classified as SSI (all treated) and 178 as not infected (25 treated). All infected babies were identified but the error of the positive predictive value reached 62.5%.Revaluation of treatment decisions with CRP cut-off levels of 15, 20 and 25 mg/l showed respectively 60.5%, 51.6 and 48% of error of the positive predictive value, the first two cut-offs missing no infected newborns but the last one missing two.A new scoring system including CRP at 20mg/l has been in use since then without readmissions for infection and an estimated reduction of 24% antibiotic treatment.

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Diagnostic Use of C-Reactive Protein (CRP) in Assessment of Neonatal Sepsis

Cited by 36 publications

References 16 publications

Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock

Predictive monitoring for sepsis and necrotizing enterocolitis to prevent shock

C-Reactive Protein in Neonatal Sepsis

Targeting Asymptomatic Term and Late Preterm Newborns at Risk for Early Sepsis: C Reactive Protein 20mg/L Threshold

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