The Role of Serial Serum C-Reactive Protein in the Diagnosis and Duration of Antibiotic Therapy in Neonatal Sepsis

Abstract

ABSTRACTBackground : the management of neonatal sepsis(N.S.) especially in developing countries is problematic. There is no single reliable marker of infection available at the present. C-reactive protein (CRP) has long been used as a marker of infection. Serial measurements of CRP are recommended as a guide for duration of antibiotic therapy. Objective : to evaluate the serial CRP measurements as a guide line for diagnosis and monitoring therapy and determining the duration of antibiotic treatment in suspected neonatal sepsis.Methods : Two hundreds neonates with clinical diagnosis of neonatal sepsis (patients group) and 200 neonates admitted or visited the outpatient clinic of the hospital for causes other than neonatal sepsis (control group) were enrolled in this prospective study. Blood culture & serial CRP were done for all patients group while single CRP was done for control group.Results : Of 200 infants (patients group), 90 (45%) had positive blood culture. CRP was negative on first and third day in 54 neonates (27%) of patients group while it was positive in 8 neonates (4%) of control group. CRP had sensitivity of (73%) and specificity of (96%). It's positive predictive value was (94.8%) whereas it's negative predictive value was (78%).Conclusion : single negative CRP value does not exclude N.S. and two negative CRP values, 24 hours apart can exclude the probability of N.S. and allow pediatricians to discontinue antibiotics.