The usefulness of serial C‐reactive protein measurement in managing neonatal infection

Abstract

Recent advances in laboratory technology have enabled us to measure C-reactive protein with a higher sensitivity in a short period using a minimal amount of blood. Thus C-reactive protein can be measured easily several times a day. In this study, serial changes in C-reactive protein values were evaluated in 108 term and 240 preterm newborn infants with suspicion of infection, and the changing patterns of C-reactive protein values were compared with clinical outcome. For a diagnosis of infection, the negative predictive values in term and preterm infants were 99.0% and 97.8%, respectively, although the sensitivities were 61.5% and 75.0%, respectively. Antibiotic therapy was started at birth and discontinued when the changing pattern of C-reactive protein and clinical findings did not suggest infection. As a result, mean durations of administration of antibiotics in the term and preterm infants were 3 and 4 days, respectively. Recognition of the changing pattern of C-reactive protein was very useful in excluding infection and minimizing unnecessary antibiotic therapy in managing neonatal infection.

Improved Outcome of Infants Born at less than 24 Weeks of Gestation in Japan

“…Preventing infection by meticulous care and gentle handling to avoid excess stress are also very important. Serial C-reactive protein (CRP) measurements is useful to early detection of infection and moreover, to reduce unnecessary use of antibiotics [14]. Lastly the optimistic attitude toward successful survival by avoiding eugenic though is the most important of all for the success of managing these marginal viable infants [9].…”

Childhood Bacterial Meningitis and Usefulness of C-reactive Protein

“…C-reactive protein (C-RP), an acute phase reactant, has been used to diagnose and follow the course of infection [2]. Its advantages include its very low serum levels in normal infants and children, a rapid rise within 12 to 24 hours of infection and a large incremental increase thereafter.…”

Can Fullterm and Nearterm Infants at Risk for Sepsis be Managed Safely Without Antibiotics?

“…Increased sensitivity is also noted with serial CRP determinations, which have proven to be valuable in establishing the diagnosis, monitoring the disease course, and determining the appropriate length of antibiotic therapy. 4,5 A persistent increase in CRP at 48 hours after birth is highly suggestive of infection.…”

“…Maternal antibiotic therapy has been reported to sterilize the blood cultures in infected offspring without eradicating serious infections such as pneumonia and meningitis, 19 which usually develop as the result of bacteremia. 4 †Remainder of data obtained during the first 3 days of life from both term and preterm infants. 5 Consensus as to when to initiate antibiotic therapy in the asymptomatic high-risk newborn has not been reached.…”