DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20211938

Role of C-reactive protein and gastric aspirate polymorphs in early onset neonatal sepsis

Sukhdeep Kaur, Kunwar Pal Singh

Abstract


Background: Neonatal septicemia is a major cause of morbidity and mortality in the neonates. It presented a diagnostic challenge in the resource poor setting of most of the developing countries of world.

Methods: This prospective observational study included all term and preterm babies inborn and outborn referred cases. We included neonates less than 7 days of age with clinical suspicion of sepsis. Significant values for screening tests were taken as total leucocyte count (TLC) of >25,000/<5000, C-reactive protein>0.6 mg/dl and gastric aspirate polymorphs>5 per HPF. Sepsis screen was considered positive for two or more positive tests. Blood culture was used as the gold standard. The statistical analysis was done using SPSS 22.0 version.

Results: A total number of 60 subjects were included in the study with 45 (75%) as outborn neonates. Most of them presented with tachypnea followed by difficulty in feeding and lethargy. Significant p values were observed using CRP and gastric aspirate polymorphs as independent sepsis screening markers and when combined together (p<0.001).

Conclusions: Sepsis screen in neonates is required for detection of infection as blood culture may be negative and even positive result takes time. CRP showed high sensitivity. Gastric aspirate cytology with its relatively high specificity and negative predictive values serves as a good screening tool to rule out neonates unaffected by sepsis. When all the three parameters were combined together, sensitivity and specificity increased to 100% and 91.67% respectively with p values of 0.001.


Keywords


Sepsis, Neonates, CRP, TLC, Blood culture

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References


Mondal SK, Nag DR, Bandyopadhyay R, Chakraborty D, Sinha SK. Neonatal sepsis: role of a battery of immunohematological tests in early diagnosis. Int J App Basic Med Res. 2012;2(1):43-7.

Chekkali C, Bapanpally N, Varahala AM. Correlation of gastric aspirate polymorphs and acute phase reactants (M-Esr, CRP and band cell count) with blood culture in early onset neonatal sepsis-a tertiary care study. IOSR-JDMS. 2017;16(6):36-42.

Singh M. Care of the Newborn. 6th ed. New Delhi: Sagar Publications; 2004: 209-18.

Plazek MM, White LA. Early and late neonatal septicemia. Arch Dis Child. 1983;58(9):728-31.

Gluck L, Wood HF, Fousek MD. Septicemia of the newborn. Pediatr Clin North Am. 1966;13(4):1131-47.

Klein JO, Remington JS. Infectious diseases of the fetus and newborn infant. 5th ed. Philadelphia: WB Saunders; 2001: 943-98.

Blanc WA. Amniotic infection syndrome. Clin Obstet Gynecol. 1959;2:705.

Benirschke K., Driscoll SG. The pathology of the human placenta. 4th ed. New York: Springer-Verlag; 2000: 108.

Chekkali C, Bapanpally N, Varahala AM. Correlation of gastric aspirate polymorphs and acute phase reactants (M-Esr, CRP and band cell count) with blood culture in early onset neonatal sepsis-a tertiary care study. IOSR-JDMS. 2017;16(6):36-42.

Agarwal RC, Ansari Z, Ahmed SH, Dutta AK Kumar R. Gastric aspirate examination for early detection of neonatal septicemia. Ind Paediat. 2003(1);7:458-9.

Kumar R, Reddy B, Soren C, Reddy V, Raheemunisa. Gastric aspirate cytology as a screening tool for neonatal sepsis-a prospective study from a tertiary care centre. Int J Contemp Pediatr. 2018;5(4):1662-5.

Berger C. Comparision of C-reactive protein and white blood cell count with differential in neonates at risk for septicemia. Eur J Pediatr. 1995;154(2):138-44.

Jaswal RS, Kaushal RK, Goel A, Pathania K. Role of CRP in deciding duration of antibiotic therapy in neonatal septicemia. Indian Pediatrics. 2003;40(9):880-3.

Escobar GJ. What have we learned from observational studies on neonatal sepsis? Pediat Crit Care Med. 2005;6(3):138-45.

Vasan UN, Dia LM, Greenstein RM, Raye JR. Origin of gastric aspirate poly-morphonuclear leucocytes in infants born after prolonged rupture of membranes. J Pediatr. 1977;91(1):69-72.

Singh M, Narang A, Bhakoo ON. Evaluation of sepsis screen in the diagnosis of neonatal sepsis. Indian Pediatr. 1987;24(1):39-40.

Kite P, Millar MR. Comparision of five tests in the diagnosis of neonatal bacteremia. Arch Dis Child. 1983;63(6):639-43.

Kaur S, Singh K. Role of C-reactive protein and immature to total neutrophil ratio in early onset neonatal sepsis. Ind J Neonat Med Res. 2021;9(1):6-9.

Chatterjee K, Mandal PK, Rahaman SR, Malathi R, Ray SK, Dutta A, et al. Raised IL-6 and C-reactive protein in neonatal sepsis in Eastern India. Int J Contemp Pediatr. 2017;4(5):1590-4.

Mally P, Xu J, Hendricks-Muñoz KD. Biomarkers for neonatal sepsis: recent developments. Res Reports Neonatol. 2014;4:157-68.

Prashant A, Vishwanath P, Kulkarni P, Narayana PS, Gowdara V, Nataraj SM, et al. Comparative assessment of cytokines and other inflammatory markers for the early diagnosis of neonatal sepsis: a case control study. PLoS ONE. 2013;8(7):68426.

Mathai E, Christopher U, Mathai M, Jana AK, Rose D, Bergstrom S. Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection? Indian Pediatr. 2004;41(9):895-900.

Ng PC. Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonat Ed. 2004;89(3):229-35.

Gyllensvärd J, Ingemansson F, Hentz E, Studahl M, Elfvin A. C-reactive protein and clinical symptoms-guided strategy in term neonates with early-onset sepsis reduced antibiotic use and hospital stay: a quality improvement initiative. BMC Pediatr. 2020;20:531.

Chandana A, Rao MN, Srinivas M, Shyamala S. Rapid diagnostic tests in neonatal septicemia. Indian J Pediatr. 1988;55(6):947-53.

Garland SM, Bowman ED. Reappraisal of C-reactive protein as a screening tool for neonatal sepsis. Pathology. 2003;35(3):240-3.

Leibovich M, Gale R, Slater PE. Usefulness of the gastric aspirate examination in the diagnosis of neonatal infection. Trop Geog Med. 1987;39(1):15-7.

Tayal M, Sharma AK, Sharma R. Incidence of culture proven neonatal sepsis, pattern of antibiotic sensitivity and clinical course in neonatal intensive care unit in tertiary care center in North India. Int J Contemp Pediatr. 2019;6(6):2419-27.

Khatua SP, Das AK, Chaterjee BD, Khatua S, Ghose B, Saha A. Neonatal septicemia. Indian J Pediat. 1986;53(4):509-14.

Shah P, Gadhvi K, Muliya B, Shah K. Neonatal sepsis-blood culture, antibiotic stewardship and clinico-bacteriological study. Int J Contemp Pediatr 2020;7(12):2376-81