title: Markedly raised levels of C-reactive protein are associated with culture-proven sepsis or necrotising enterocolitis in extremely preterm neonates.
abstract: OBJECTIVE
  A serious inflammatory process is suspected when C-reactive protein (CRP) is very high, and we established the causes and outcomes when CRP was >100 mg/L in neonates.
  
  
  METHODS
  We retrospectively reviewed all 277 episodes where CRP exceeded 100 mg/L between January 2007 and December 2011 at a tertiary neonatal unit.
  
  
  RESULTS
  Of the 6025 neonates admitted during the study period, 258 had CRP >100 mg/L at least once. The overall mortality rate was 44/258 (17%); 36 died within 7 days of CRP >100 mg/L, and 34 were extremely preterm infants. CRP exceeded 100 mg/L in 106 infants within the first 3 days of life - 74 term, 25 preterm and seven extremely preterm - with no infection identified in 81%. In contrast, infections were found in 87% of the 171 episodes from day four of life - 129 extremely preterm, 23 preterm and 19 term - predominantly coagulase-negative staphylococcus sepsis and necrotising enterocolitis.
  
  
  CONCLUSIONS
  Markedly elevated CRP in the first 3 days of life was most likely to affect term neonates (74/106) with no infectious cause (81%). However, CRP >100 mg/L from the fourth day of life was most likely to affect extremely preterm neonates (129/171) and have an infectious cause (87%).
authors.affiliation: Neonatal Unit, Liverpool Women's Hospital, Liverpool, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Keane
authors.affiliation: Neonatal Unit, Liverpool Women's Hospital, Liverpool, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Fallon
authors.affiliation: Neonatal Unit, Liverpool Women's Hospital, Liverpool, UK.|Department of Paediatric Infectious diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Riordan
authors.affiliation: Neonatal Unit, Liverpool Women's Hospital, Liverpool, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Shaw
mesh_terms: D000367:Age Factors; D002097:C-Reactive Protein / Q000378:metabolism*; D020345:Enterocolitis, Necrotizing / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000382:microbiology / Q000401:mortality; D013203:Staphylococcal Infections / Q000097:blood / Q000175:diagnosis* / Q000401:mortality
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; Neonatal sepsis; Neonate; Preterm; Term