Abstract
We prospectively compared the diagnostic value of C-reactive protein (CRP) and white blood cell counts for detection of neonatal septicaemia. Sensitivity and specifity in receiver operating characteristics, and positive and negative predictive value of CRP and white blood cell count were compared in 195 critically ill preterm and term newborns clinically suspected of infection. Blood cultures were positive in 33 cases. During the first 3 days after birth CRP elevation (sensitivity 75%, specifity 86%), leukopenia (67%/90%), neutropenia (78%/80%) and immature to total neutrophil count (I/T) ratio (78%/73%) were good diagnostic parameters, as opposed to band forms with absolute count (84%/66%) or percentage (79%/71%), thrombocytopenia (65%/57%) and toxic granulations (44%/94%). Beyond 3 days of age elevated CRP (88%/87%) was the best parameter. Increased total (84%/66%) or percentage band count (79%/71%) were also useful. Leukocytosis (74%/56%), increased neutrophils (67%/65%), I/T ratio (79%/47%), thrombocytopenia (65%/57%) and toxic granulations had a low specifity. The positive predictive value of CRP was 32% before and 37% after 3 days of age, that of leukopenia was 37% in the first 3 days.
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Abbreviations
- CRP :
-
C-reactive protein
- I/T :
-
immature to total neutrophil count
- NPV :
-
negative predictive value
- PPV :
-
positive predictive value
References
Ainbender E, Cabatu E, Guzmann D, Sweet A (1990) Serum C-reactive protein and problems of newborn infants. J Pediatr 101:438–440
Akenzua GI, Hui YT, Milner R, Zipurski A (1974) Neutrophil and band counts in the diagnosis of neonatal infections. Pediatrics 54:38–42
Alt R, Willars D, Messer J, Metais P, Goester C, Mard J (1982) Intérêt de la protéine C rèactive dans les infections bactériennes néonatales. Arch Fr Pediatr 39:811–813
Benuck I, David RJ (1983) Sensitivity of published neutrophil indexes in identifying infants with sepsis. J Pediatr 103:961–963
Blau N, Fanconi S (1986) Determination of CRP using the RA-1000. J Clin Chem Clin Biochem
Christensen R, Rothstein G, et al (1984) The leucozyte left shift in clinical and experimental neonatal sepsis. J Pediatr 98:101–105
Coulombel L, Vial M, Dehan M, Hill C, Tchernia G (1980) Intérêt des données hématologiques pour le diagnostic d'infection materno-foetale. Arch Fr Pediatr 37:385–391
Fehlmann U, Loher E, Fanconi A (1976) Quantitative Untersuchungen der stabkernigen und segmentkernigen neutrophilen Granulozyten beim Neugeborenen. Helv Paediatr Acta 31: 21–32
Gerdes J, Polin R (1987) Sepsis screen in neonates with evaluation of plasma fibronectin. Pediatr Infect Dis J 6:443–446
Kind C (1982) Die Bedeutung des Blutbildes für die Diagnose der frühbeginnenden Sepsis des Neugeborenen. In: Huch A, Huch R, Duc G (eds) Klinisches Management des kleinen Frühgeborenen. Thieme, Stuttgart, pp 228–232
Kite P, Millar MR, Gorham P, Congdon P (1988) Comparison of five tests used in diagnosis of neonatal bacteriemia. Arch Dis Child 63:639–643
Klein J, Marcy J (1990) Bacterial sepsis and menigitis. In: Remington J, Klein J (eds) Infectious dieases of the fetus and newborn infant. Saunders, Philadelphia, pp 627–637
Kuchler H, Fricker H, Gugler E (1976) La formule sanguine dans le diagnostic précoce de la septicémie du nouveauné. Helv Paediatr Acta 31:33–46
Magny J, Benattar C, Vauzelle D, et al (1984) C-reactive protéine et infection néonatale. Intérêt diagnostique. Arch Fr Pediatr 41:167–170
Manroe B, Weinberg A, Rosenfeld C, Browne R (1979) The neonatal blood count in health and disease I. Reference values for neutrophilic cells. J Pediatr 95:89–98
Mathers N, Pohlandt F (1987) Diagnostic audit of C-reactive protein in neonatal infection. Eur J Pediatr 146:147–151
Philip AGS (1990) Neonatal sepsis: problems of diagnosis and the need for prevention. In: Duc G (ed) Prevention of infections and the role of immunoglobulins in the neonatal period. Royal Society of Medicine Services International Congress and Symposium Series London No. 163: 9–18
Philip AGS, Hewitt JR (1980) Early diagnosis of neonatal sepsis. Pediatrics 65:1036–1041
Pourcyros M, Bada H, Korones S, et al (1993) Significance of serial C-reactive responses in neonatal infection and other disorders. Pediatrics 92:431–435
Rodwell RL, Leslie A, Tudehope D (1988) Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr 112:761–767
Russell G, Smyth A, Cooke R (1992) Receiver operating characteristic curves for comparison of serial neutrophil band forms and C reactive protein in neonates at risk of infection. Arch Dis Child 67:808–812
Sabel K, Wadsworth C (1979) C-reactive protein in early diagnosis of neonatal septicaemia. Acta Paediatr Scand 68:825–831
Speer C, Bruns A, Gahr M (1983) Sequential determination of CRP, α-1-antitrypsin and haptoglobulin in neonatal septicaemia. Acta Paediatr Scand 72: 679–683
Töllner U (1982) Early diagnosis of septicaemia in the newborn. Clinical studies and sepsis score. Eur J Paediatr 138:331–337
Wasunna A, Pepys M, et al (1990) C-reactive Protein and bacterial infection in preterm infants. Eur J Pediatr 149: 424–427
Weinstein MC, Fineberg HV (1980) Clinical decision. Saunders, Philadelphia, Chap. 4
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Berger, C., Uehlinger, J., Ghelfi, D. et al. Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia. Eur J Pediatr 154, 138–144 (1995). https://doi.org/10.1007/BF01991918
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DOI: https://doi.org/10.1007/BF01991918