C-Reactive Protein: A Tool for Guiding Duration of Antimicrobial Therapy in High-Risk Neonates

Serial measurements of C-reactive protein (CRP) values along with other indices for screening for neonatal sepsis, including total white cell count (TWCC), absolute neutrophil count (ANC), immature to total neutrophil ratio (l:T ratio) and blood culture, was studied in three forty six neonates, with risk factors, admitted to SCBU, at the neonatal department of Al Galaa teaching hospital. All infants with suspected bacterial infection, either EOS ( 72 hours age) or LOS ( 72 hours age) were started on antibiotic treatment according to the department guidelines. The data for indices of infection were collected and analyzed for sensitivity, specificity, PPV NPV. A cut off value for a significant CRP was ≥ 12mg% to suspect neonatal infection in the presence of suggestive clinical manifestations. It was found that serial CRP measurements had a sensitivity of 91 % and a specificity of 59%. The PPV for serial CRP values was 90.03% (95% CJ 85-92%) and the NPV was 61 % (95% CI 48-73%). The combination of CRP and I:T ratio raised the sensitivity to 93%, while combining CRP, ANC and I:E ratio raised the sensitivity further to 97%. These results make the use of serial measurements of CRP values for the diagnosis of EOS LOS and to guide antibiotic therapy in these infants a safe and practical approach.