C-Reactive Protein (CRP) and Neonatal Early-Onset Sepsis (EOS) Calculator as Tools for Diagnosis of Neonatal Sepsis

Aim: To evaluate and compare the performance of the EOS risk calculator with CRP values for predicting neonatal EOS.

Methods: This is a retrospective study, which reviewed medical records of all symptomatic neonates that were evaluated for neonatal sepsis after birth. we compared the CRP test results to the calculator`s recommendations and the blood culture results.

Results: A total of 382 newborns who underwent sepsis work-up due to equivocal symptoms were included in our study, in 315 cases the calculator recommended routine vitals without blood test, having reduced the number of newborns who underwent a sepsis work-up by 82.5%. 163 neonates (42.7%) were treated with antibiotics while the neonatal EOS calculator recommended antibiotics for only 27 infants, so the total number of infants treated with antibiotics would have been reduced by 83.4%. Taking into account that 373 of 382 (97.6%) cases ultimately had no sepsis, the specificity of the calculator is higher than that of the CRP test, 83.9% versus 76.1%, respectively. When comparing the maximal CRP value with the risk according to the neonatal sepsis calculator, a significant correlation was found between them (P<0.01), but the relationship was not strong (Pearson`s correlation=0.27).

Conclusion: The high sensitivity of the calculator makes it possible to avoid a large amount of blood tests and antibiotic treatment for non-infected neonates. Using CRP tests can greatly reduce the number of infected newborns that the calculator may miss, but at the cost of taking multiple blood tests and providing unnecessary antibiotic therapy to a significant number of newborns.