Skip to main content
Log in

Diagnostic audit of C-reactive protein in neonatal infection

  • Original Investigations
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

A prospective study of 250 consecutive neonatal admissions to a regional perinatal referral centre and of 10 additional consecutive cases with culture-proven neonatal septicaemia was undertaken. Quantitative C-reactive protein (CRP) determination, white cell count and differential were performed on blood samples obtained from all babies on admission, as well as 10–14 h and 22–26 h later. Using clinical signs, chest X-rays, blood cultures, tracheal aspirates obtained within 4 h of delivery and an abnormal immature/total neutrophil ratio (I/T), infected babies were defined as belonging to one of the following groups: (1) Culture-proven septicaemia (n=19); (2) Clinical septicaemia (n=35); (3) Congenital pneumonia (n=28). The sensitivity, specificity, positive and negative predictive value of CRP were calculated for each sampling time and patient group. No baby had a rise in CRP (>6mg/l) before an abnormal I/T ratio was first detected. A delayed rise in CRP concentration in the majority of infected babies occurred approximately 12–24 h after the abnormal I/T ratio was first detected. The overall specificity of a CRP level of ≥10 mg/l remained approximately constant (97%–94%) while sensitivity increased from 22%–61% with increasing time after admission. The same pattern emerged if each patient group was considered separately. The positive predictive value for a CRP level of ≥10mg/l 22–26 h after admission was 83% and the negative predictive value 82%. CRP had no value in the early diagnosis of neonatal infection. Its main role lies rather in the exclusion or confirmation of infection 24 h after the first clinical suspicion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CRP:

C-reactive protein

I/T:

immature/total

AFR:

acute phase reactant

References

  1. Ainbender E, Cabatu EE, Guzman DM, Sweet AY (1982) Serum C-reactive protein and problems of newborn infants. J Pediatr 101:438–440

    CAS  PubMed  Google Scholar 

  2. Alt R, Willars D, Messer J, Metais P, Goester C, Mard JJ (1982) Interêt de la C réactive protéine dans les infections bacteriennes néonatales. Arch Fr Pediatr 39:811–813

    CAS  PubMed  Google Scholar 

  3. Amato M, Ruckstuhl C, von Muralt G (1984) C-reaktives Protein im Serum Frühgeborener. Schweiz Med Wochenschr 114:412–414

    CAS  PubMed  Google Scholar 

  4. Coulombel L, Vial M, Dehan M, Hill C, Tchernia G (1980) Interêt des données hématologiques pour le diagnostic d'infection materno-foetale. Etude prospective chez 240 nouveau nes. Arch Fr Pediatr 37:385–391

    CAS  PubMed  Google Scholar 

  5. Gewurz H, Mold C, Siegel J, Fiedel B (1982) C-reactive protein and the acute phase response. Adv Intern Med 27:345–372

    CAS  PubMed  Google Scholar 

  6. Gill CW, Bush S, Burleigh WM, Fischer CL (1981) An evaluation of a C-reactive protein assay using a rate immunonephelometric procedure. Am J Clin Pathol 75:50–55

    CAS  PubMed  Google Scholar 

  7. Künzer W, Uhlig T (1983) Zur Bedeutung des C-reaktiven Proteins (CRP) im Serum bei bakeriellen Infektionen von Frühgeborenen. Monatsschr Kinderheilkd 131:573–576

    PubMed  Google Scholar 

  8. Lloyd BW, Oto A (1982) Normal values for mature and immature neutrophils in very preterm babies. Arch Dis Child 57:233–235

    CAS  PubMed  Google Scholar 

  9. Magny JF, Benattar C, Vauzelle D, Delaporte B, Lindenbaum A, Dehan M, Gabilan JC (1984) C-réactive protéine et infection néonatale. Interét diagnostique. Arch Fr Pediatr 41:167–170

    CAS  PubMed  Google Scholar 

  10. Manroe BL, Weinberg AG, Rosenfeld CR, Browne R (1979) The neonatal blood count in health and disease I. Reference values for neutrophilic cells. J Pediatr 95:89–98

    CAS  PubMed  Google Scholar 

  11. Matesanz JL, Malaga S, Santos F, Nuno F, Ramos A, Crespo M (1980) Valor diagnostico de la proteina C reactiva en la sepsis neonatal. An Exp Pediatr 13:671–677

    CAS  Google Scholar 

  12. Nicolopoulos D, Perakis A, Papadakis M, Alexion D, Aravantinos D (1976) Estimation of gestational age in the neonate. A comparison of clinical methods. Am J Dis Child 130:477–480

    CAS  PubMed  Google Scholar 

  13. Philip AGS (1979) The protective effects of acute phase reactants in neonatal sepsis. Acta Paediatr Scand 68:481–483

    CAS  PubMed  Google Scholar 

  14. Philip AGS (1981) Decreased use of antibiotics using a neonatal sepsis screening technique. J Pediatr 98:795–799

    CAS  PubMed  Google Scholar 

  15. Philip AGS (1984) Acute-phase proteins in neonatal infection. J Pediatr 105:940–942

    CAS  PubMed  Google Scholar 

  16. Philip AGS, Hewitt JR (1980) Early diagnosis of neonatal sepsis. Pediatrics 65:1036–1041

    CAS  PubMed  Google Scholar 

  17. Pilars de Pilar CE, Raschke P, Lischka N, Krejci K (1980) Akute Phase — Proteine bei Früh- und Neugeborenen. Klin Pädiatr 192: 45–50

    CAS  PubMed  Google Scholar 

  18. Sabel KG, Hanson A (1974) The clinical usefulness of C-reactive protein (CRP) determination in bacterial meningitis and septicaemia in infancy. Acta Paediatr Scand 63:381–388

    CAS  PubMed  Google Scholar 

  19. Sabel KG, Wadsworth CH (1979) C-reactive protein (CRP) in early diagnosis of neonatal septicaemia. Acta Paediatr Scand 68: 825–831

    CAS  PubMed  Google Scholar 

  20. Sann L, Bienvenu F, Bienvenu J, Bourgeois J, Bethenod M (1984) Evolution of serum prealbumin, C-reactive protein and orosomucoid in neonates with bacterial infection. J Pediatr 105: 977–981

    CAS  PubMed  Google Scholar 

  21. Sherman MP, Goetzman BW, Ahlfors CE, Wennberg RP (1980) Tracheal aspiration and its clinical correlates in the diagnosis of congenital pneumonia. Pediatrics 65:258–263

    CAS  PubMed  Google Scholar 

  22. Speer CH, Bruns A, Gahr M (1983) Sequential determination of CRP, alpha-1-antitrypsin and haptoglobulin in neonatal septicaemia. Acta Paediatr Scand 72:679–683

    CAS  PubMed  Google Scholar 

  23. Sternberg JC (1977) Rate nephelometer for measuring specific proteins by immuno precipitin reactions. Clin Chem 23:1456–1464

    CAS  PubMed  Google Scholar 

  24. Töllner U (1982) Early diagnosis of septicaemia in the newborn. Clinical studies and sepsis score. Eur J Pediatr 138:331–337

    Article  PubMed  Google Scholar 

  25. Wauer RR, Herrman H, Duda M, Lau W, Decker B, Windt E, Pawlow J, Thümmler CH, Schamlisch G, Grauel EL (1982) Frühdiagnose neonataler Infektionen mit C-reaktivem Protein (CRP). Kinderärztl Prax 9:452–462

    Google Scholar 

  26. Galen RS, Gambino SR (1975) In: Beyond Normality — The predictive value and efficiency of medical diagnosis. Wiley, New York, p 6

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mathers, N.J., Pohlandt, F. Diagnostic audit of C-reactive protein in neonatal infection. Eur J Pediatr 146, 147–151 (1987). https://doi.org/10.1007/BF02343221

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02343221

Key words

Navigation