Background and aims Early-onset neonatal bacterial infection (within 72 h of birth) is a significant cause of mortality and morbidity in newborn babies. This study was aimed to evaluate laboratory values (Full blood count, FBC and C-Reactive Protein, CRP) of neonates identified at being risk of early-onset infection and establish a correlation to the severity of risk factors or clinical condition of the neonate.
Method We prospectively collected data of neonates at risk over a 2 month period. Perinatal risk factors were derived from the National Institute of Clinical Excellence (NICE) guideline. Identified neonates had blood cultures, FBC and CRP collected prior starting antibiotics. CRP was repeated 24 hrs later. Lumbar puncture was performed in neonates with CRP ≥30.
Results A total of 73 babies were identified, out of which 9 (12.3%) were late preterm. 19 out of 73 (23%) neonates had elevated CRP and were treated for 5 to 7 days. 10 out of these 23 (43.4%) neonates had maternal pyrexia as a risk factor. All babies have been clinically well and managed on postnatal ward. Blood cultures in all identified neonates have been negative. 30 out of 54 (55%) neonates with normal CRP stayed in hospital for more than 48 hrs awaiting blood culture results and clinical reviews.
Conclusion The identification of neonates at risk is a combination of perinatal risk factors, which are neither specific nor sensitive and infant laboratory values. This approach leads to clinicians treating well appearing infants for an extended period of time.