IJCRR

IJCRR - 5(12), June, 2013

Pages: 32-38

Date of Publication: 28-Jun-2013

VALUE OF C-REACTIVE PROTEIN IN NEONATAL SEPTICEMIA

Author: Deepandra Garg, Shalini Bajaj, Neha Agrawal, Manish bajaj

Category: Healthcare

Abstract:Objective \- To assess the value of c-reactive protein as a diagnostic tool in neonatal septicemia, To find prognostic value of quantitative assay of serial CRP in neonatal septicemia and usefulness of serial CRP for guiding duration of antibiotic therapy in neonatal septicemia. Research Design and Methods MATERIALS AND METHODS
A total of 35 full-term neonates of birth weight >2.5 kg admitted in Nursery Balchikitsalaya RNT Medical College, Udaipur (Lodger and intramural) were included and undertook relevant routine investigation to assess the neonatal septicemia i.e. blood was taken for blood culture, blood cell count with differential and quantitative CRP and micro ESR. Results\- C-reactive protein is having >90% sensitivity in diagnosis of neonatal septicemia as compared with other parameters of sepsis screening. A serial decline in CRP value has a strong positive correlation with duration of antibiotic therapy. (P < 0.001) Conclusions- C-reactive protein is highly sensitive test in diagnosis of neonatal septicemia.CRP estimation should also be done on day-4 i.e. after 72 hours of starting antibiotic therapy in a septic newborn. Persistently high values have prognostic implications and antibiotics should be changed if clinically justified. Serial CRP estimation have greater value as compared to single CRP estimation in judging the course and outcome of neonatal septicemia.

Keywords: C–Reactive Protein, Neonatal Septicemia, Blood culture, Blood cell count.

Full Text:

INTRODUCTION
Perinatal infection especially neonatal bacterial sepsis is the commonest cause of neonatal mortality and morbidity in India.Current neonatal mortality rate (NMR) of India is about 34/1000 live births.(1) Sepsis accounts for almost half of the deaths that occur during neonatal period. Globally WHO estimates 5 million neonatal deaths a year, infection contributes 30-40% of neonatal deaths globally.(2) Sepsis neonatrum is the completely curable life-threatening disease of the newborn. Prompt institution of specific anti-bacterial therapy can be life saving and can reduce neonatal morbidly and mortality up to a large extent. Newborn is a relatively compromised host who is unable to localize the infection and bacterial sepsis can frequently involve vital organs including meninges. This results in non-specific subtle signs and symptoms, which intrigue even the most astute clinician, the two major problems which concern the neonatal physician are, Is it septicemia? And if confirmed as septicemia, whether the patient is improving? There is no rapid and reliable test for the confirmation of the etiologic diagnosis. The treatment is generally started when early markers of neonatal infection (sepsis screen), support clinical picture.(3) A number of acute-phase proteins serve as useful indicators of infection in the neonates viz. C-reactive protein, alpha-1 acid glycoprotein, heptoglobin, ?-1 antitrypsin, fibrinogen, pre albumin, transferrin etc. These markers are still in a controversial status and none of them has until now established for clinical purpose.(4,5) The best studied amongst them is C-reactive protein. C-reactive protein is synthesized in the liver in response to inflammatory cytokinines. Because of its shorter half-life of 19 hours, its level rises with inflammation and accurately parallel with the activity of the inflammation and quickly fall after efficient eliminations of the microbial stimulus. While a high CRP is of important role in diagnosis, treatment and monitoring of inflammatory disorders. Also serial decline in CRP with therapy is suggestion of adequate response to antibiotics and recovery.(6)

A level of >16 mg/L on day 1 and 2 of life and >10mg/L on subsequent day in the newborn period is considered as abnormal in neonates.(7) A quantitative CRP by immune-turbidimetric test is most accurate, rapid and reliable method which will thus be directly indicating whether the neonate is having septicemia or not.(8) Septicemia of newborn infants can be effectively treated by prompt intravenous antibiotic therapy. Once therapy has been initiated it is important to assess whether the chosen treatment is indeed effective. A successful treatment will be accompanied by a decline in CRP to normal (i.e. <10mg/L), while a rise in CRP beyond the third day of empirical treatment would give rise to a suspicion of ineffective antibacterial treatment or fungal infection. (9) This study of exact quantitative CRP value is being planned to assess therapeutic response to antibiotics and to know the relation of prognosis to initial absolute levels.

MATERIALS AND METHODS
A total of 35 full-term neonates of birth weight >2.5 kg admitted in Nursery Balchikitsalaya RNT Medical College, Udaipur (Lodger and intramural) were included. The study was carried out during the month of March to May of year 2006. Permission was taken from the Institutional Ethics Committee. Inform consent was taken from parents of neonates.

Inclusion criteria were:

• Symptoms and signs suggestive of septicemia with positive sepsis screen.(10)

Exclusion Criteria

• Neonates with birth asphyxia (APGAR score <5 at 5 minutes).
• Neonates with Meconium aspiration syndrome.
• Neonates who had previously received antibiotics in any form.
• Patient undergoing surgery or major chromosomal / congenital malformation.
• Neonates <1.5 kg and gestational age <28 weeks.

Procedure
After the first clinical suspicion of infection, blood was taken for blood culture, blood cell count with differential and quantitative CRP and micro ESR. Antibiotic therapy with a standard regimen of Ampicillin/Cefotaxim and Gentamycin/Amikacin was started in all neonates with suspension of septicemia. Sepsis screen was done on the time of admission i.e. 0 hours and then again at 4th day i.e. after 72 hours and again on 8th day i.e. 168 hours and if sepsis screen is not negative on 8th day then again on 14th day. Hence a total of three or four value of CRP in all selected neonates were known by quantitative assay (immunoturbidimetric method). (8)The initial CRP level and their rate of fall studied and correlated with outcome of neonates. Antibiotics were stopped whenever CRP levels are <10mg/L. If CRP value on day