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C-reactive protein and the neonatal early-onset sepsis calculator for the diagnosis of neonatal sepsis

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Our aim was to evaluate the utility of the neonatal early-onset sepsis risk calculator (NEOSC) to the utility of C-reactive protein (CRP) for diagnosing neonatal EOS. This retrospective study reviewed the records of neonates who underwent sepsis workups due to equivocal symptoms and compared their CRP values to the calculator’s recommendations and their cultures. A total of 382 newborns who underwent sepsis work-up due to equivocal symptoms were included in our study. The calculator’s recommendations would have reduced the number of newborns who underwent sepsis workups by 82.5% and antibiotic treatment by 83.4% (n = 315). Considering that 373 of 382 (97.6%) ultimately had no sepsis, the calculator’s specificity was higher than that of CRP (83.9% versus 76.1%). When comparing the maximal CRP value with the risk according to the neonatal sepsis calculator, a significant correlation was found between them (P < 0.01), but the relationship was not strong (Pearson’s correlation = 0.27). We found a significant correlation between the risk of sepsis according to the NEOSC and the CRP values, although the correlation was not strong. The calculator’s high specificity enables safe avoidance of multiple blood tests and antibiotic treatments for suspected neonates who are not infected. CRP tests can reduce the number of infected newborns the calculator may miss, at the cost of unnecessary blood tests and antibiotic therapy to many newborns.

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Abbreviations

CRP:

C-reactive protein

EOS:

Early onset sepsis

GBS:

Group B streptococcus

NEOSC:

Neonatal early-onset sepsis risk calculator

NICU:

Neonatal intensive care unit

NPV:

Negative predictive value

References

  1. Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, Newman TB, Zupancic J, LiebermanE DD (2014) Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks’ gestation. Pediatrics 133(1):30–36

    Article  Google Scholar 

  2. Weston EJ, Pondo T, Lewis MM, Martell-Cleary P, Morin C, Jewell B, Daily P, Apostol M, Petit S, Farley M, Lynfield R, Reingold A, Hansen IN, Stoll BJ, Shane AL, Zell E, Schrag SJ (2011) The burden of invasive early-onset neonatal sepsis in the United States, 2005–2008. Pediatr Infect Dis J 30(11):937–941

    Article  Google Scholar 

  3. Van Herk W, Stocker M, van Rossum AM (2016) Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use. J Infect 5(72):S77–S82

    Article  Google Scholar 

  4. Kumar V, Shearer JC, Kumar A, Darmstadt GL (2009) Neonatal hypothermia in low resource settings: a review. J Perinatol 29(6):401–412

    Article  CAS  Google Scholar 

  5. Doctor BA, O’Riordan MA, Kirchner HL, Shah D, Hack M (2001) Perinatal correlates and neonatal outcomes of small for gestational age infants born at term gestation. Am J Obstet Gynecol 185(3):652–659

    Article  CAS  Google Scholar 

  6. Voora S, Srinivasan G, Lilien LD, Yeh TF, Pildes RS (1982) Fever in full-term newborns in the first four days of life. Pediatrics 69(1):40–44

    CAS  PubMed  Google Scholar 

  7. Boyle RJ, Chandler BD, Stonestreet BS, Oh W (1978) Early identification of sepsis in infants with respiratory distress. Pediatrics 62(5):744–750

    CAS  PubMed  Google Scholar 

  8. Chan DK, Ho LY (1997) Usefulness of C-reactive protein in the diagnosis of neonatal sepsis. Singap Med J 38(6):252–255

    CAS  Google Scholar 

  9. Kuzniewicz MW, Puopolo KM, FischerA WEM, Li S, Newman TB, Kipnis P, Escobar G (2017) A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr 171(4):365–371

    Article  Google Scholar 

  10. Dhudasia MB, Mukhopadhyay S, Puopolo KM (2018) Implementation of the sepsis risk calculator at an academic birth hospital. Hosp Pediatr 8(5):243–250

    Article  Google Scholar 

  11. AchtenN B, Dorigo-Zetsma JW, van der Linden PD, van Brakel M, Plötz FB (2018) Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis. Eur J Pediatr 177(5):741–746

    Article  Google Scholar 

  12. Strunk T, Buchiboyina A, Sharp M, Nathan E, Doherty D, Patole S (2018) Implementation of the neonatal sepsis calculator in an Australian tertiary perinatal centre. Neonatology 113(4):379–382

    Article  Google Scholar 

  13. Hofer N, Zacharias E, Müller W, Resch B (2012) An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 102(1):25–36

    Article  CAS  Google Scholar 

  14. Lai MY, Tsai MH, Lee CW, Chiang MC, Lien R, Fu RH, Huang HR, Chu SM, Hsu JF (2015) Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≤10 mg/L). BMC Infect Dis 15:320

    Article  Google Scholar 

  15. Sundarapandian S, Chinnakkannan S, Ahmed M, Das R (2017) Utility of serial serum C-reactive protein in the diagnosis of neonatal infection. Indian J Child Health 4:374–378

    Article  Google Scholar 

  16. Benitz WE, Han MY, Madan A, Ramachandra P (1998) Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 102(4):e41–e41

    Article  CAS  Google Scholar 

  17. Benitz WE, Gould JB, Druzin ML (1999) Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics 103(6):e77–e77

    Article  CAS  Google Scholar 

  18. Klingenberg CA, Kornelisse R, Buonocore G, Maier RF, Stocker M (2018) Culture-negative neonatal sepsis–at the crossroad between efficient sepsis care and antimicrobial stewardship. Front Pediatr 9(6):285

    Article  Google Scholar 

  19. Cantey JB, Wozniak PS, Pruszynski JE, Sánchez PJ (2016) Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. Lancet Infect Dis 16(10):1178–1184

    Article  Google Scholar 

  20. Goel N, Shrestha S, Smith R, Mehta A, Ketty M, Muxworthy H, Abelian A, Kirupaalar V, Saeed S, Jain S, Asokkumar A, Natti M, Barnard I, Pitchaikani PK, Banerjee S (2020) Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population. Arch Dis Child Fetal Neonatal Ed 105(2):F118–F122

    Article  Google Scholar 

  21. MurkW RKR, Bracken MB (2011) Prenatal or early-life exposure to antibiotics and risk of childhood asthma: a systematic review. Pediatrics 127(6):1125–1138

    Article  Google Scholar 

  22. Saari A, Virta LJ, SankilampiU DL, Saxen H (2015) Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life. Pediatrics 135(4):617–626

    Article  Google Scholar 

  23. Corvaglia L, Tonti G, Martini S, Aceti A, Mazzola G, Aloisio I, Gioia DD, Faldella G (2016) Influence of intrapartum antibiotic prophylaxis for group B streptococcus on gut microbiota in the first month of life. J Pediatr Gastroenterol Nutr 62(2):304–308

    Article  CAS  Google Scholar 

  24. Cantey JB, Baird SD (2017) Ending the culture of culture-negative sepsis in the neonatal ICU. Pediatrics 140(4):e20170044

    Article  Google Scholar 

  25. Schelonka RL, Chai MK, Yoder BA, Hensley D, Brockett RM, Ascher DP (1996) Volume of blood required to detect common neonatal pathogens. J Pediatr 129(2):275–278

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neonatology, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nati Friedman, Sivan Yochpaz, Semyon Zirkin, Jacky Herzlich & Ronella Marom

  2. Department of Neonatology, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel

    Ronella Marom

Authors
  1. Nati Friedman
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  2. Sivan Yochpaz
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  3. Semyon Zirkin
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  4. Jacky Herzlich
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  5. Ronella Marom
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Contributions

NF and RM conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. SY and JH conceptualized and designed the study, and coordinated and critically reviewed the manuscript for important intellectual content. ST and NF designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ronella Marom.

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The authors declare that they have no conflict of interest.

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Not applicable.

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Not applicable.

Ethical approval

This study was approved by the Institutional Review Board of Tel Aviv Medical Center (approval number: 0216-18TLV April 18, 2018). Informed consent was waived because all data were de-identified.

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What is known:

• Both the NEOSC and the blood tests for CRP assessments are useful tools for detecting early sepsis in neonates with suspicious symptoms.

What is new:

• While we did find a significant correlation between the risk of sepsis according to the NEOSC and the CRP values, it was not a strong one.

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Friedman, N., Yochpaz, S., Zirkin, S. et al. C-reactive protein and the neonatal early-onset sepsis calculator for the diagnosis of neonatal sepsis. Eur J Clin Microbiol Infect Dis 40, 1227–1234 (2021). https://doi.org/10.1007/s10096-021-04156-y

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  • DOI: https://doi.org/10.1007/s10096-021-04156-y

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