Comparative Study between C-Reactive Protein and Other Hematological Parameters in the Diagnosis and Treatment of Neonatal Sepsis in Term Neonates

Abstract

Neonatal sepsis N. S. is one of the major causes of morbidity and mortality in neonates. The management of the N. S., especially in developing countries, is problematic. There is no single reliable marker of infection available at present. There are many attempts to develop screening tests or scoring systems that can identify infected infants at the time of initial assessment, sparing others from invasive diagnostic procedures, intravenous antibiotics therapy, mother-infant separation, and parental anxiety. The objective of the study is to analyze hematological parameters and C-reactive protein (CRP) so as to evaluate their diagnostic value in neonatal sepsis (N. S.) and determine the duration of antibiotics treatment in suspected N. S. A prospective study was performed in the neonatal care unit and general wards at Karbala Teaching Hospital for Children during a period from the first of November 2019 to the end of September 2020. (166) neonates with a clinical diagnosis of neonatal sepsis (patients group) and (50) neonates admitted or visited the outpatient clinic of the hospital for causes other than neonatal sepsis (control group) were enrolled in this prospective study and evaluated for a set of investigations including blood culture, CRP, White Blood Cell count (WBC), Absolute Neutrophil count (ANC), Platelets count, and Immature to Total neutrophil ratio (I/T ratio) was done for all patients group while single CRP was done for the control group. One hundred sixty-six neonates (patients’ group) and 82 neonates (49.4%) had positive blood cultures. CRP was positive on the first day in 114 neonates (68.7%) and negative in 52 neonates (31.3%), while it was positive in 3 neonates of the control group. CRP had a sensitivity of (69%), specificity (of 94%), positive predictive value (of 67.5%), and negative predictive value (of 47.5%). The sensitivity of Platelets count, I/T ratio, and WBC were (30%), (27%) and (24%) respectively. A 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 the pediatrician to discontinue treatments. N. S. with documented pneumonia necessitates prolonged antibiotics therapy, just like meningitis. Total W. B. C. count, ANC, Platelets counts, and I/T ratio have the lowest sensitivity in both cultures positive and culture negative N. S.