Method This was derived from a retrospective audit on newborns who underwent sepsis screen if they meet the screening criteria (risk factors and or clinical indicators of infection) as recommended in NICE guideline. LP was performed for clinical reason or if the CRP value equal or greater than 10 mg/L or those with positive blood cultures.
Result Total 50 neonates. All of them had blood cultures performed, CRP range was from <2 to 124, 20 had elevated CRP, 23 neonates had LP, 9 were preterm and the rest were term neonates.
7/50 neonates who undergone sepsis screen had elevated first CRP, 20/50 had elevated second CRP and 5/50 had elevated third CRP.
All seven neonates with elevated first CRP had subsequently elevated second CRP. All five neonates with elevated third CRP had elevated second CRP.
13 neonates who had normal first CRP subsequently went on to have elevated CRP in the repeat test after 24 h.
LP was performed in 23/50 neonates. 20 had elevated CRP and additional three lumbar punctures were performed for clinical reasons.
Those neonates who received antibiotics for a duration ranging from 36 h to 72 h, all of them had normal first and repeat CRP.
The newborns who received antibiotics for 5 days or more (25 neonates), seven had elevated first CRP, 20 had elevated second CRP and 5 neonates had elevated 3rd CRP.
Conclusion CRP is a late specific diagnostic test. Serial measurements will improve diagnostic sensitivity and this gives us a trend which guides us for treatment. NICE recommended risk factors and clinical indicators helped us to pick 20/50 neonates with elevated CRP. Those with elevated CRP, 13 showed CRP elevation only in repeat after 24 h. Hence NICE recommended risk factors and clinical indicator is a good infection screening tool for initiation of investigations and treatment.