High Sensitive C-reactive Protein For The Early Diagnosis Of Neonatal Sepsis

Objective:Neonatal sepsis is a major cause of morbidity and mortality in newborn infants.It is vital to identify infected neonates as early as possible,but unreliable clinical signs and the absence of good diagnostic tests hinder an accurate early diagnosis.Thus,sick neonates are frequently treated with broad-spectrum antibiotics.Then antibiotics abuse has contributed to the emergence of multi-resistant bacteria,and even the increase in mortality.The identification of the infected neonate remains one of the most difficult tasks in clinical medicine.C-reactive protein(CRP), one of the acute phase proteins,has been used to diagnose neonatal sepsis.But the immunoreaction of newborn is low,so maybe the level of CRP only raised slightly when infected.The aim of our study was to assess the value of high sensitive C-reactive protein for the early diagnosis of neonatal sepsis.Methods:The study was retrospective analysis.One hundred and ninty-three neonatal cases of suspect bacterial infection with infectious risk factors or infectious symptoms were enrolled.The neonates were composed of male(n=123),and female (n=70);or premature(n=18),postmature(n=l),and mature(n=174)according to gestational age;or neonates with sepsis(n=46),neonates with local bacterial infection (n=69)and neonates without bacterial infection(n=78)according to final clinical diagnosis.Serum hs-CRP levels on admission were checked and recorded.According to aims of our study,neonates were divided into different groups and draw receiver operator characteristic curve(ROC)to establish the cutoff value in diagnosing neonate sepsis,and compare the value of hs-CRP with traditional CRP test for the early diagnosis of neonate sepsis.Results:Hs-CRP concentration was 12.00±22.816 mg/L in neonates with sepsis,1.83±4.967 mg/L in neonates with local bacterial infection,and 1.79±4.231 mg/L in neonates without bacterial infections.The concentration in neonates with sepsis was much higher than other groups(P＜0.05).Hs-CRP concentration was 11.31±32.589 mg/L in neonates with culture-proven sepsis,and 12.27±18.262 mg/L in neonates with Clinical sepsis,they were not significantly different(P＞0.05).Area under the ROC curve was 0.651±0.052 in all neonates,95%CI 0.548-0.751.when the cutoff value was 4mg/L,the sensitivity is 47.8%,the specificity is 83.0%,Youden index is 0.304;when the cutoff value was 8mg/L,the sensitivity is 30.4%,the specificity is 97.3%,Youden index is 0.277.The sensitivity is not significantly different(P＞0.05),but the specificity of 8mg/L is high than the specificity of 4mg/L (P＜0.05).Conclusion:Hign sensitive C-reactive protein can differentiate between sepsis and local bacterial infection,and still useful for diagnosing clinical sepsis.However hs-CRP is not very exactly for the early diagnosis of neonatal sepsis.And the study also shows it is not better than the traditional CRP test.