Role of Serial C-reactive Protein (CRP) in Relation to Total Leucocyte Count, Platelet Count & Blood Culture for early Diagnosis of Neonatal Septicemia in Developing Countries

Abstract

Abstract:Neonatal septicemia is a clinical syndrome of systemic illness accompanied by bacteremia occuring in the first 28 days of life. Neonatal septicemia is one of the major causes of neonatal death in developing countries. Early diagnosis and treatment can prevent neonatal mortality and morbidity. The present study includes: 1) usefulness of CRP (C-reactive protein), Total Leucocyte Count, Platelet Count and Blood Culture in early diagnosis of Neonatal Sepsis, 2) significance of serial CRP in diagnosis of neonatal sepsis. 3) the prognostic value of CRP in neonatal sepsis. This is a prospective study done in neonatal ward, Chittagong Medical College Hospital and carried out from January 2008 to January 2011. Sample size was 300. One hundred fifty neonates with suspected sepsis as cases and 150 healthy babies as control were enrolled in this study. Seventy two percent of cases neonates were preterm and low birth weight. Common risk factors for neonatal septicemia which were identified in this study; preterm (72%), low birth weight (72%), premature rupture membrane (60%), chorioamnionitis (26%) and maternal urinary tract infection (16%) . Out of 150 cases of suspected neonatal sepsis total 80.7%% had raised CRP, in initial sample 70.39% were CRP positive and in 2 nd sample additional 9.31% case were CRP positive . In control group 91% were CRP negative. CRP was positive in 100% of culture proven sepsis. Sensitivity of CRP was 80.67% and specificity of CRP was 76.44%. Leucocytosis was observed in 7% of cases and leucopenia was found in 11% of cases. In 82 % cases leucocyte count was found normal. In control group, 95% had normal leucocyte count and 5% had leucocytosis but no leucopenia. Sensitivity of leucocyte count was 18% and specificity was 20.68%. Thrombocytopenia was found in 28% of case group. Out of 150 cases only 15.33% yielded growth of organisms in blood culture. Klebsiella was the most common pathogen isolated which was followed by E.coli and Strph. aureus. Sensitivity of blood culture was 15.33% and specificity was 100% Therefore serial CRP can be taken as alternative method for diagnosis of neonatal sepsis specially in developing countries where blood culture is not readily available.

Utilidad de la proteína C-reactiva en la sepsis neonatal temprana

“…Sin embargo, los intervalos de confianza son muy amplios, configurando un gran margen entre pacientes con elevaciones secundarias a infección u otras causas no infecciosas, que no fueron evaluadas en el presente estudio. Barua y cols., también evaluó el comportamiento de muestras seriadas en pacientes que estaban recibiendo manejo antimicrobiano para sepsis neonatal temprana; encontró en una primera muestra un resultado positivo en 70,4%, y en la segunda muestra tan solo en 9,3% de los casos 26 . Tal hallazgo indica un significado más pronóstico que diagnóstico y representa su mejor utilidad en la evaluación de la respuesta al tratamiento.…”

Evaluation of C-Reactive Protein in Iraqi Children Presented with Acute Enteropathogenic Escherichia Coli Associated Diarrhea with Special Emphasis to Age and Gender

“…It plays a role in innate immunity as an early defense system against infections. CRP rises within 2-6 hours of the onset of inflammation, up to a 50,000-fold, and peaks at 48 hours (6). Its half-life of 18 -19 hours is constant, and therefore its level is determined by the rate of synthesis in the and production from liver as well as by other cells such as adipocytes and hence the severity of the precipitating cause (7) .…”