Value Of Laboratory Tests And C - Reactive Protein In The Detection Of Neonatal Sepsis

摘要

Background: Neonatal sepsis are a major cause of death world wide ,which diagnosed by obtaining positive blood culture. The aim of study was to determine if any laboratory tests can predict neonatal sepsis prior to positive blood culture.Method: the medical records of 200 infants, aged <30 days, with suspected infection, who where admitted in Mostafakhomeini hospital in Tehran, where reviewed retrospectively. Based on clinical and biological findings, diagnoses were categorized in to 3 groups as follow: A: proven sepsis with positive blood culture. B: probable sepsis with negative blood culture but laboratory consist with sepsisC: clinically sepsis with out any positive culture or laboratory abnormalities.The validity of laboratory tests which had performed as sepsis work-up, were compared against positive blood culture as gold standard test.Results: of 200 infants 19(9.5%) had positive blood culture.The most common causative organisms were klebsiella (5) staphylococous aurous (5) and staph Coagolase negative (5). Among laboratory tests, CRP had the best sensitivity (79%) and negative predictive value (97%) ,but poor positive predictive value (36%), the specificity of it was 85%.Conclusion: no laboratory tests alone can be used as early detection of septicemia accurately. Introduction Sepsis is a bacteria blood stream infection identified by one or more positive blood cultures in the presence of clinical signs of infection (1, 2).Neonatal septicemia is a major cause of mortality and morbidity world wide.(3,4,5) early detection of sepsis in neonate is one of the most difficult problems facing neonatal care providers and clinicians today.(2,6)The clinical and laboratory signs of neonatal sepsis are often non specific (1, 4, 7, 8) how ever empirical treatment should not be delayed, because failure or delay in treatment may resulting significant mortality and morbidity. (1, 5, 7) On the other hand, the ability to early diagnosis or rule out neonatal sepsis results in to limit inappropriate antibiotic exposure and lowering the cost of therapy. (9, 10) Many studied have investigated a variety of laboratory tests to enhance the early detection of neonatal sepsis .(2,5,8,10,17)Some evidence exist which support the use of C-reactive protein measures sole or in conjunction with other tests to identify neonate at risk for septicemia. (2, 5, 10, 13, 15, 17) In contrast some authors believed no advantage for using it.(8,12,14) This study was conducted to determine the value of some laboratory test in early detection for neonatal septicemia .Besides this, we wish to know the comment causal organisms for neonatal sepsis in our situations. Material And Methods Through a retrospective study, we reviewed the medical records of infants, aged <30 days, suspected of sepsis who were admitted in NICU of Mostafakhomeini hospital in Tehran between Mar,2000 and sep,2001.Infants who were received antibiotics prior to septic work up were excluded.200 eligible infants had investigated for infection included CBC, serum electrolyte, Arterial blood gases, ESR and CRP measurements, blood, urine and cerebro spinal fluid cultures .CRP had measured qualitatively. (a positive test result indicates a CRP level more than 6mg/l or more than 10mg/l).Based on clinical and biological data, diagnosis of infants categorized in to 3groups as follow: proven sepsis with positive blood culture, probable sepsis (clinically and laboratory consistent with sepsis but negative blood culture). clinically sepsis (only clinically consistent with sepsis with out any laboratory abnormalities and positive cultures). All infants following the septic work up, were received antimicrobial therapy. Statistical analysis was performed using one way ANOVA and TURKEY tests for continuous variables or β2 tests for categorical variables (spss 9.0 for window's). P values<0.05 were considered significant.Positive blood culture was considered the “gold standard” against which the performance of CRP,