The Accuracy of CRP Levels for Detection of Early Onset Sepsis

Background: Early-onset sepsis (EOS) remains a common and serious problem for neonates. National Institute for Health and Care Excellence(NICE) CG149 guidelines has advised to considered performing a lumbar puncture (LP) to investigate for neonatal meningitis in early-onset sepsis when a C-reactive protein (CRP) level >10mg/L, but the evidence for this recommendation is poorly defined.

Aim: To identify the accuracy of C-reactive protein levels for diagnosis of neonatal sepsis and meningitis

Methods: A retrospective study was conducted at the neonatal unit in Hull Royal infirmary hospital. We included all symptomatic new-borns who were admitted to NICU and had who LP from January 2017-February 2019. This study included all babies who had diagnosed with EOS and had LP. 43 babies were included in this study over that period.

Results: The median gestational age was 40wk(range31:42). The age of onset of starting having symptoms was ranged from 0 to 26hours. The median result of the first and second CRPs were 5.9mg/dl(0.2:95) and 65 mg/dl(1.5:219),respectively. 4 out 43(9%) babies had positive blood culture and no CSF positive cultures. 2/43 (5%) treated as meningitis due to high WBC counts in CSF. The median the second CRP results in those who had negative cultures was lower 63mg/dl(1.5:219) than those had positive cultures 90mg/dl(10:127). The sensitivity and specificity of the second CRP in diagnosis of acute neonatal sepsis was 10% and 80% respectively. The duration of antibiotics was 5days in 70% (n,30) of the cases and only 23%(n,10) had course of antibiotics more than 5days and remaining (n,3) completed 2days duration of antibiotics.

Conclusions: The sensitivity of CRPs in detection of neonatal sepsis with positive cultures shows poor value. Therefore, decision to perform LP following CRPs results should be explored further.