Comparative utility of C reactive protein and Blood culture for diagnosis of neonatal septicaemia

Abstract

Introduction: Neonatal septicaemia constitutes a significant cause of morbidity and mortality of neonates in India. The diagnosis of neonatal septicemia based on clinical manifestations is nonspecific which leads to initiation of unnecessary antibiotic treatment. Blood culture remains the gold standard for the diagnosis of neonatal sepsis. But many times, culture may be negative in symptomatic neonates, preterm neonates or very low birth weight babies. Further difficulty with blood culture is turnaround time of at least 18-24hrs and this facility is available only in well-equipped centers. C-reactive protein (CRP) production is a nonspecific response to a disease but along with clinical symptoms, it is helpful for the diagnosis of neonatal septicaemia. Methods: In this one year prospective study, 257 clinically suspected cases of neonatal septicaemia were enrolled. Screening for CRP was done by quantitative method and cut off value of CRP was taken as 6mg/l. Simultaneously, blood culture was done by automated BACTEC 9240 system. Results: Out of 257 cases, 67 showed positive CRP and 20 cases showed positive blood culture. The predominant organisms were Staphylococcus species followed by Escherichia coli. CRP test showed 50% sensitivity and 77%specificity, considering blood culture as gold standard method. Conclusion: CRP is a rapid tool for screening of neonatal septicaemia and a reliable marker in the absence of positive blood cultures. The use of both CRP and blood culture in combination would increase the yield of laboratory confirmed neonatal septicaemia cases.