Early C-Reactive Protein (CRP) as Predictor of Neonatal Morbidity 1118

Background: CRP, an acute phase reactant of hepatic origin rises during inflammation and tissue injury. Its determination has been suggested as a useful indicator of sepsis in the newborn but its value as a predictor of neonatal morbidity has been debated. Also, studies on the value of cord and CRP taken within the first six hours of life (early CRP) are needed.Goals: 1.To analyze the relationship between early CRP values and maternal and neonatal factors. 2.To define the role of early CRP as a predictor of the duration of hospitalization. Methods: We determined prospectively early CRP on newborns admitted to the normal nursery(88 infants), the neonatal intensive care (13) and the intermediate care nursery (17). The following data was collected prospectively on each newborn: sex, gestational age, birth weight, Apgar score, maternal age, mode of delivery, presence or absence of meconium, hyperbilirubinemia, hemolysis, sepsis, perinatal complications and maternal drug intake. The correlation of each of these factors with CRP and of CRP with duration of hospitalization was then investigated. CRP was meassured using an automated immunoturbidometric assay (kit purchased from Randox Lab. UK) on a Hitachi 911 analyser. Statistical analysis was performed using the Fisher's exact test.Results: There was a significant association between early CRP and sepsis (specificity 90%, sensitivity 56%) as well as the following variables: gestational age, birth weight, Apgar score at one minute, mode of delivery, hyperbilirubinemia, hemolysis, (p 0.05). The most significant association was between an early CRP value of ≥ 0.3 mg/dl and duration of hospitalization of ≥ 3 days (p<0.0001), the sensitivity and specificity being 42% and 97% respectively. Conclusions : 1.Early CRP is specific for sepsis but not as sensitive. It is affected by a number of other factors. 2.Early CRP of ≥ 0.3 mg/dl is a specific but not sensitive predictor of hospitalization for three or more days.