Reappraisal of C-reactive protein as a screening tool for neonatal sepsis.

AIMS: To assess the usefulness of C-reactive protein (CRP) [either alone or in combination with a full blood examination (FBE) and microbiology of gastric aspirate] in predicting the diagnosis of neonatal sepsis compared with routinely available markers of infection.

METHODS

A prospective study of quantitative CRP, FBE, gastric aspirate and surface swab microscopy and culture in predicting neonatal sepsis in a level III perinatal referral hospital was performed.

RESULTS

Of 301 episodes evaluated over a 5-month period, there was a 5% rate of major (culture proven) sepsis (3% early onset, <72 hours) and 10% rate of modified sepsis. No single test alone was sufficiently reliable as an indicator of infection to be a satisfactory screening tool for early onset sepsis [CRP sensitivity 67%, negative predictive value (NPV) 86%, FBE sensitivity 63%, NPV 80%, gastric aspirate sensitivity 57%, NPV 83%].

CONCLUSION

The three-test combination had a sensitivity of 97%, NPV 98% and likelihood ratio of 49, thus providing a useful diagnostic tool.