C-REACTIVE PROTEIN KINETICS IN TERM AND PRETERM BABIES WITH EARLY ONSET SEPSIS AND ITS ASSOCIATION WITH BLOOD CULTURE
Keywords:C-reactive protein, Early onset neonatal sepsis, Preterm, Septic screen, Term
Objective: To determine C-reactive protein kinetics in term and preterm babies with early onset sepsis and its association with blood culture.
Study Design: Cross sectional study.
Place and Duration of Study: Neonatal intensive care unit, department of pediatrics, Liaquat College of medicine and dentistry and Darulsehat hospital Karachi, from Jan 2017 to Jan 2018.
Methodology: One Hundred and Two neonates with presumed early onset sepsis (within 72 hours of birth) were enrolled in the study. Blood samples drawn for septic work up including baseline C-reactive protein levels. Blood culture collected with all recommended a-septic measures and is taken as gold standard for proven sepsis diagnosis. C-reactive protein considered positive when >6 mg/dl in preterm and >10mg/dl in term babies.
Results: Out of 102 enrolled neonates, among C-reactive protein positive cases, 42.1% aged <24 hours, 50% were male, 47.5% had low birth weight, 63.2% were term, 36.8% preterm, 42% had positive blood culture, 5.3% observed with less than five thousand WBC, and 44.7% observed with more than twenty-five thousand WBC. Among these parame-ters blood culture and WBC >25000 gives significant association with C-reactive protein (p<0.01).
Conclusion: Despite being septic, premature and low birth weight babies are unable to mount significant Creactive protein levels/C-reactive protein levels in these neonates do not effectively correlate with infectivity. Our study showed strong association of baseline C-reactive protein with WBC >25000/cumm and blood culture in term babies whose birth weights were appropriate for gestational age. To conclude, prematurity and low birth weight have negative association with C-reactive protein positivity hence in addition to clinical signs and risk factors, other sepsis screen parameters like interleukin, procalciton in should be taken into consideration before decision of antibiotic discontinuation in these neonates with presumed EOS.