Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection?
OBJECTIVE
To document effects of intrapartum risk factors for early onset sepsis (EOS) on CRP levels in neonates and to assess the suitability of this test in diagnosing EOS.


METHODS
Cohort study.


METHODS
Labour and post natal wards in a tertiary level teaching hospital in India.


METHODS
250 neonates at risk of developing infection.


METHODS
CRP levels in cord blood and neonatal blood at 24 hrs were estimated using commercial kits. Babies were observed for signs of sepsis for at least 48 hours.


RESULTS
Seven (2.8 Percent) neonates had elevated CRP levels in the cord blood. At 24 hours, 102 (40.8 Percent) babies had elevated levels. Elevated cord CRP levels was significantly associated with rupture of membranes for 24 hours (p =0.04), labour more than 12 hours (p = 0.002), and maternal fever (p = 0.01). At 24 hours, elevated CRP levels were associated with primiparity (p= 0.006), more than three vaginal examinations after membrane rupture (p=0.02), meconium staining of amniotic fluid (p =0.02) and amnioinfusion (p =0.02). Ten (4 Percent) babies developed EOS. The negative predictive value for elevated CRP levels at 24 h was 99 Percent.


CONCLUSIONS
Several intrapartum risk factors for EOS can cause elevation in CRP levels. However, this test may be useful in excluding infection.
Department of Microbiology, Christian Medical College, Vellore, India 632004. mathaim@cmcvellore.ac.in
Elizabeth
E
Mathai
Usha
U
Christopher
Matthews
M
Mathai
Atanu Kumar
AK
Jana
Dolly
D
Rose
Staffan
S
Bergstrom
D002097:C-Reactive Protein / Q000378:metabolism*; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*
D002097:C-Reactive Protein