Abstract
Background Infection remains a significant cause of morbidity in neonatal intensive care. Differentiation between sepsis and clinical deterioration from other causes is difficult. It would be of great value if quick and simple laboratory data support evidence of septic disease. Aim Commonly available laboratory data (Hemoglobin (Hb), white blood cell count (WBC) and C-Reactive Protein (CRP) were analysed for their reliability in predicting disease of infectious origin in newborns admitted to a neonatal intensive care unit (NICU).
Results 102 hospitalised newborns were analysed during a 3-months' study period. 81 newborns had one or more episodes of suspected sepsis and antibiotics were started 105 times. In 17 (20%) out of 85 obtained bloodcultures an organism was isolated. Newborns with lower birth weight and gestational age were more likely to have a positive bloodculture (1430 g vs 2070 g and 30 weeks vs 32.5 weeks, both p<0.01). Hb was significantly lower (7.9 vs 9.6 mmol/L, p<0.01), and the CRP higher (26 vs 8 mg/L, p<0.001) in newborns with a positive blood culture. WBC was similar in both groups. A CRP > 20 mg/l was 94% specific for a positive blood culture. In combination with a low Hb (< 8 mmol/L) or low WBC (< 8), specificity increased to 98% and 100%. Corresponding sensitivities were low (35%). Subset analysis in newborns with late onset sepsis showed no significant differences in CRP, Hb or WBC due to the small number of patients (n=13 and n=15). The specificity of CRP > 20 mg/l persisted (93%) and increased to 100% in combination low WBC. Low Hb had no more additive effect (specificity stayed 93%).
Conclusion A low Hb and/or low WBC with an elevated CRP are highly specific for a positive blood culture in premature low birth weight infants. In case of late onset sepsis the Hb is not discriminating.
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Van Der Gaag, E., Scholvinck, E., Bergman, K. et al. 387 Anemia and Elevated C-Reactive Protein in Premature Low Birth Weight Infants as Predictors of Positive Blood Cultures. Pediatr Res 58, 420 (2005). https://doi.org/10.1203/00006450-200508000-00416
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DOI: https://doi.org/10.1203/00006450-200508000-00416
