C-Reactive Proteins as diagnostic and prognostic indicator in neonatal sepsis

Background: Many biomarkers have been proposed and assessed clinically to optimize the survival rates in septic patients, but none alone is specific enough to definitively determine diagnosis. The present study was undertaken to assess the role of C-reactive proteins ( CRP) as a promising marker in diagnosis of neonatal sepsis and also determine the utility of CRP as a prognostic indicator in neonatal sepsis. Methods: The study was conducted in 200 neonates admitted in NICU who fulfilled criteria of neonatal sepsis as per guidelines of National Neonatology Forum over a period of 2 years. Detection of CRP in human serum was done by the rapid slide latex agglutination qualitative method with cut off value of CRP being 6mg/dl. Result: CRP was positive in 71.60% and negative in 28.4% of babies on day 1 of admission. All the cases were followed subsequently with starting of empirical antibiotics therapy and CRP repeated on day 5 and day 10 / or on discharge. It showed that CRP positivity decreased over these periods to 10%. Negative predictive value of Serial CRP increases from 41% on day 1 to 96% on day 10 / or on discharge, which signifies that serial CRP value rules out sepsis with high accuracy and helpful in deciding duration of antibiotics in neonatal sepsis. Sensitivity of Serial CRP increases from 35% on day 1 to 59% on day10 / or on discharge which was significant. Mean duration of antibiotics on the basis of serial CRP values in neonates was reduced from 13 days in non-study group to 8 days, which was significant. Conclusion: The serial CRP measurement is a good indicator for discontinuing antibiotic therapy in neonates with suspected sepsis and a useful diagnostic and prognostic marker in neonatal sepsis.