Use of a single C-reactive protein level in decision-making during neonatal sepsis evaluation

Abstract

Background: Use of a single C-reactive protein (CRP) level has been studied in the pediatric population, but limited information is available for the neonatal, particularly Neonatal Intensive Care Unit (NICU) infants. Objective: The objective of this study is to determine if a single CRP level in the context of other laboratory and clinical parameters, can assist in decision-making for antibiotic management. Materials and Methods: We reviewed the medical records of infants admitted to a large regional perinatal center NICU over a 2-year period. Infants in whom a CRP level had been measured were divided into sepsis-treated group if antibiotic therapy was instituted for ≥7 days or the no sepsis group if antibiotics were discontinued after 48 h. Characteristics of delivery, general characteristics of the infant and data at the time of sepsis evaluation were collected. This was a powered study to detect at least 10% difference in the proportion of those with CRP P = 0.0016). When infants were evaluated based on CRP level, we found that 67% of the infants with CRP P = 0.002). Conclusion: A single CRP level done at the time of a neonatal sepsis evaluation can assist in decision-making regarding the continuance of antibiotic therapy. The use of CRP among infants undergoing sepsis evaluation in the NICU significantly affected the decision of medical providers to discontinue antimicrobial agents. This is consistent with the American Academy of Pediatrics Committee on Fetus and Newborn recommendation that bacterial sepsis is unlikely with normal CRPs and antibacterial agents may be discontinued.