C-Reactive Protein as an Index of Early Diagnosis of Neonatal Sepsis
Patricia I. Eniowo
Department of Paediatrics, Mother and Child Hospital, Akure, Ondo-State, Nigeria.
Abiodun J. Kareem *
Department of Paediatrics, Federal Medical Centre, Owo, Ondo State, Nigeria.
Akinbowale R. Eniowo
Department of Obstetrics and Gynaecology, Federal Medical Centre, Owo, Ondo State, Nigeria.
Ebunoluwa A. Adejuyigbe
Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Osun-State, Nigeria.
Korede O. Oluwatuyi
Department of Paediatrics, Federal Medical Centre, Owo, Ondo State, Nigeria.
Opeyemi O. Akinmadelo
Department of Paediatrics, Federal Medical Centre, Owo, Ondo State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Neonatal sepsis is a major cause of morbidity/mortality and the definitive diagnosis is an isolation of the pathogen from blood culture which might take 2-7 days. A test for early confirmation of infection is therefore required. C-reactive protein (CRP) is therefore suggested as an early screening tool in the diagnosis of neonatal sepsis.
Aim: To determine the usefulness of CRP in the early diagnosis of neonatal sepsis among neonates.
Study design: This was a prospective longitudinal study.
Place of the study: Department of Paediatrics, Obafemi Awolowo University Teaching Hospital Complex Ile-Ife.
Methods: Consecutive neonates were recruited. Blood culture was done and CRP was done at contact and 24 hours. Data were analysed and P = .05 was considered significant.
Results: A total of 180 neonates comprising 106 (58.9%) males with a male to female ratio of 1.4:1 were studied. Thirty-two (17.8%) of the neonates had culture-proven sepsis with a prevalence of 10.1% among the inborn and 23.8% among the out-born with statistically significant difference (χ2 = 5.638, P = .018). The means of initial and repeat CRP for subjects with culture-proven sepsis were 41.4 (23.6) mg/l and 10.6 (4.3) mg/l respectively while subjects without sepsis were 9.2 (11.3) mg/l and 6.1 (2.6) mg/l respectively (P < .001). The CRP has a sensitivity of 93.8%, specificity 91.9%, negative predictive value 98.6%, and positive predictive value of 71.4%. The area under the curve for the receiver operator characteristic curve for subjects with CRP ≥ 10mg/L and positive culture was 0.909 (P < .001).
Conclusion: The CRP has a high sensitivity, specificity, and negative predictive value and can therefore be used to screen neonates with sepsis.
Keywords: Blood culture, C-reactive protein, neonate, sepsis