crp in neonates

1. Evaluation of CRP as an inflammatory biomarker as a predictor
in neonatal sepsis
- Dr. Aakansha Rajeev, guided by Dr Pavithra Jain

2. NEED FOR THE STUDY
 In developing countries, Neonatal sepsis has
ranked as one of the leading causes of neonatal
mortality and morbidity. CRP is an acute phase
marker that is rapid and easily available as a
predictor for inflammation prognosis and sepsis
evaluation. Though blood culture is a gold
standard, it is affected by antiobiotic admistration.
CRP levels have a half life of 19 hours and are
not affected by usage of antibiotics. CRP levels
decrease with reduction of antibiotics , therefore
serial CRP level assays will help in earlyu
prediction of sepsis and also helpful to taper
down antibiotic usage . High CRP values are
also associated with organ failure and increased
risk of death, hence it can be an important
prognositc marker

3. OBJECTIVES
 To assess serial CRP results in
neonates suspected with septicaemia
 To correlate blood culture values with
the CRP values
 To correlate the outcome of sepsis
after antibiotic administration and to
see the variation in further CRP values

4. METHODOLOGY OF THE
STUDY
 Study design- The present study will be
carried out innm a retrospective manner in a
tertiary care hospital for the period of 3
months that Is July-September 2022 after
obtaining institutional ethical committee
clearance. Neonates admitted in SDM
medical college NICU during this study period
will be considered as the study population.
 Inclusion criteria- All the neonates
suspected or showing sypmtoms of sepsis
during admission will be included. Neonates
diagnosed with sepsis proved by blood
culture positive results will also be included in
this study.

5.  Exclusion criteria- here all the neonates who died
immediately upon arrival to our hospital , diagnosed
with sepsis prior to admission will also be excluded.
Neonates with suspected congenitally transmitted
infection , born to mothers with STD’s, malaria will be
excluded. Children above 30 days of life are excluded.
 Data collection- Data will be collected from the
hospitals official information system, medical records
department with prior permission of the Medical
Superintend. Information regarding levels of serial CRP
assays , blood culture collection and positive or
negative reports, type of organism isolated , antibiotic
susceptibility of organism will be required.
 Sample size- Not less than 100 neonates will be
subjected to evaluation, and all the babies suspected of
sepsis will be considered.

6. OUTCOME OF THE STUDY
 A negative CRP can be useful for deciding
discontinuation of antibiotic therapy if the clinical
features of sepsis are absent. This leads to early
discharge from the hospital with a reduced cost
of health care, complications of long treatment as
well as the family anxiety . Although the CRP
shows its usefulness in the diagnosis of neonatal
sepsis, it does not substitute the microbiological
culture . The sensibility of CRP measurement
may vary according to the qualitative or
quantitative method used. CRP may be useful in
poor resource countries where blood culture is
not available or while waiting for blood culture
results. It may help deciding of initiation or
discontinuation of the empiric antibiotic therapy.

7.  Funding
 The expenses during the period of this
study, will be self funded. Since it’s a
retrospective study and all the
information needed is readily available
on our software systems and in the
medical records department.

8.  Risks and benefits of the study
 CRP has the best diagnostic accuracy when combined
with another infection marker that compensates for its
diagnostic weakness and provides reliable sensitivity
during the early phases of sepsis. Suitable markers
include but are not limited to PCT, IL-6, and IL-8. Many
further parameters may provide similar good results, but
are not yet sufficiently examined to be applied in clinical
practice.
 CRP is one of the most widely available, most studied,
and most used laboratory tests for neonatal bacterial
infection, and despite the continuing emergence of new
infection markers, it still plays a central role in the
diagnosis of early-onset sepsis of the neonate. CRP
has the advantage of being well characterized in
numerous studies, and the extensive knowledge of its
properties and limitations makes it safer compared to
other, newer markers.