ELEVATED C-REACTIVE PROTEIN VALUES IN TERM AND PRETERM NEWBORNS

Background C-reactive protein (CRP) is often described as a rather unspecific parameter in the diagnosis of early onset bacterial infection in the first days of life, coherent with other neonatal and maternal diagnosis. The objective of the study was to identify and analyse non-infection associated elevations of CRP. Methods In this retrospective analysis all newborns hospitalized in the last 4 years (2004–2007) at the NICU and having documented values of CRP within the first 72 hours of life were included. Newborns were divided in Early Onset Sepsis (EOS) positives (clinical signs of sepsis with positive culture or positive maternal risk factors or positive laboratory tests) and negatives. Results Elevated levels of CRP above 8 mg/L were found in 162 of 690 newborns (23%). 70/162 newborns (43%) were diagnosed as having EOS, and 20/162 (12%) were diagnosed as having uncertain infectious status. 72/162 newborns (44%) had elevated values of CRP not associated with EOS, diagnoses included asphyxia, respiratory distress syndrome, delayed postpartum adaptation, meconium-stained amniotic fluid, meconium aspiration syndrome, hyperbilirubinaemia and drug withdrawal, and maternal risk factors including premature rupture of the membranes, intra-amniotic infection and fever during labour. CRP values were higher in EOS positive newborns (mean 27.0±32.7 vs. 17.9±19.0 mg/L). CRP values differed between preterm and term infants (mean 13.0±23.6 vs. 5.8±10.2 mg/L) despite comparable rates of EOS (19% and 18%, respectively). Conclusion Nearly a quarter of all newborns showed increased levels of CRP during a four-year study period, and half of them were not associated with proven EOS.