Abstract:

Background: Neonatal deaths account for about 40% all deaths among under-fives worldwide. Early diagnosis and treatment of neonates with clinical suspicion of sepsis is critical in preventing life threatening complications. However, in most of the time the diagnosis based on clinical features in non-specific; therefore, initiation of the antibiotic treatment is posing to a danger of increased antibiotic resistance. In this study the utility of serial qualitative CRP assay in the diagnosis of neonatal sepsis was determined using blood culture as gold standard.

Methodology: A total of 305 neonates admitted at Bugando Medical Centre (BMC) neonatal units between September 2013 and April 2014 were enrolled. Demographic and clinical data were collected using standardized data collection tool. Blood specimens were collected for blood culture, full blood picture count and qualitative C-reactive protein (CRP) assay. CRP was measured as per manufacturer guidelines while all isolates were identified using in house biochemical tests and susceptibility performed using the disc diffusion methods as per clinical laboratory standard institute (CLSI) recommendations.

Results: Out of 305 neonates; 224(37.4%) were ≤ 72hrs of age and 91 (29.8%) neonates had low birth weight. Of 305 neonates, 180 (59%) and 31 (10.2%) had fever and convulsion respectively. The positive CRP assay was observed in 67 (22.0%), 80 (26.2%) and 88 (28.9%) of neonates on day 1, 2 and 3 respectively with any CRP positive occurred in 104(34.1%) of neonates. The sensitivities of CRP assays in the diagnosis of sepsis using culture as gold standard on day 1, 2, 3 and any positive were 40.4%, 53.2%, 54.8% and 62.9% with specificities of 82.7%, 80.7%, 77.8% and 73.3% respectively. Clinical features found independently to predict positive CRP assay were poor feeding (p=0.02) and high body temperature (p=0.02). Neonates with sepsis due to gram negative bacteria were significantly found to have rates of positive CRP than those with gram positive sepsis and those with negative culture (p< 0.001, OR 8.2, 95 CI; 2.9-26 vs P=0.04 OR 2.2, 95 CI; 0.9 – 4.9). Mortality was observed in 22(7.2%) of neonates. Neonates with positive CRP were 1.7 times more risk of death than those with negative CRP. Other factors independently associated with death were convulsions, poor feeding, and lethargy and oxygen saturation below 90%

Conclusion: About two thirds of neonates with confirmed septicemia had positive CRP with sensitivity of 90.3% in places where blood culture is limited neonates with positive qualitative CRP assay, increased WBC and suggestive clinical features of sepsis should urgently be initiated on appropriated sepsis management in order to reduce morbidity and mortality associated with neonatal sepsis. I addition negative CRP and decreased in WBC can be used to determine the duration of antibiotic treatment in places with limited blood culture facilities.