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C reactive protein: impact on peripheral tissue oxygenation and perfusion in neonates
  1. Gerhard Pichler1,
  2. Mirjam Pocivalnik1,
  3. Regina Riedl2,
  4. Elisabeth Pichler-Stachl1,
  5. Heinz Zotter1,
  6. Wilhelm Müller1,
  7. Berndt Urlesberger1
  1. 1Department of Pediatrics, Medical University Graz, Graz, Austria
  2. 2Department of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
  1. Correspondence to Gerhard Pichler, Department of Pediatrics, Medical University Graz, Auenbruggerplatz 30, Graz, Austria, 8036; pichler.gerhard{at}


Objective C reactive protein (CRP) is a sensitive marker of acute inflammation of infectious and non-infectious origin. Aim was to use near-infrared spectroscopy (NIRS) to analyse peripheral oxygenation and perfusion in term and preterm neonates with elevated CRP levels, at a time when routine haemodynamic variables are still normal.

Design Prospective observational study.

Settings Peripheral-muscle NIRS was performed in the first week of life. Tissue-oxygenation index (TOI), mixed venous oxygenation (SvO2), fractional oxygen extraction (FOE), haemoglobin flow (Hbflow), oxygen delivery (DO2) and oxygen consumption (VO2) were assessed. Blood samples were taken within 3 h of the NIRS measurements.

Patients Cardiocirculatory stable term and preterm neonates with infection-related and infection-unrelated CRP elevations >10 mg/l were compared with neonates without CRP elevation. The two groups were matched for gestational and postnatal age.

Results 33 neonates with CRP elevation (gestational age 37.7±2.9 weeks) were compared with 33 controls (gestational age 37.3±2.9 weeks). In neonates with CRP elevation, TOI (68.9±6.6%), SvO2 (66.9±7.3%) DO2 (39.2±16.1 µmol/100ml/min) and VO2 (10.9±3.4 µmol/100ml/min) were significantly lower compared with controls (TOI 72.9±3.8%, SvO2 70.2±4.7%, DO2 48.8±18.4 µmol/100ml/min, VO2 12.3±3.8 µmol/100ml/min). There was no significant difference in any other NIRS or routine haemodynamic parameter between the two groups.

Conclusion Inflammatory processes with CRP elevation cause impaired peripheral oxygenation and perfusion in neonates even when routine haemodynamic variables are still normal. NIRS might offer a new non-invasive tool for the early recognition and diagnosis of infectious and non-infectious inflammatory processes.

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  • Competing interests None.

  • Ethics approval Ethical Committee of the Medical University of Graz, Austria.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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