Value of C-Reactive Protein Level as A Predictive andقيمة مستوى بروتين (ج) النشط كعلامة تنبؤية و إنذارية في التسمم الدموي المبكر في حديثي الولادة

The aim of the present study was to determine the value of C- reactive protein as a predictive marker of early onset neonatal sepsis in newborn babies with one or more risk factors for neonatal sepsis as well as to assess its value as a prognostic marker .

This study was conducted in 90 newborn infants admitted to neonatal intensive care unite (N I C U) in teaching hospital of Benha. All studied newborns were born to mothers with at least one of the following risk factors of neonatal sepsis (premature rupture of membranes (PROM)>24 hours, more than three vaginal examinations after ROM, intrapartum fever (oral temperature >38C?), foul-smelling liquor or untreated or partially treated urinary tract infection in the antenatal period)

The following were considered to be signs suggestive of sepsis in newborns: (1) Lethargy or poor feeding, (2) axillary temperature < 36 °C or >38°C for more than one hour, (3) jaundice with serum bilirubin > 15mg% in the absence of blood group incompatibility, (4) apnea or respiratory distress, (5) capillary refill time of > 3 sec on the forehead or mid sternum, (6) heart rate > 160 /min corrected for elevation of body temperature (10beats/ c rise), (7) vomiting, diarrhea or ileus, (8) petechiae or bleeding diathesis, (9) omphalitis, (10) seizures.

The following investigations were done:

(1) Total leukocyte count.

(2)Neutrophil count.

(3) Immature to total (I/T) neutrophil ratio. (4) Serial measurements of C- reactive protein: cord blood, at 24hours and at 48 hours.

Summary 91

The results of our study showed that:

The frequency of neonatal sepsis was significantly higher among patients with fever, apnea, bleeding tendency, omphalitis, seizures or in whom the gestational age was 3 sec. On the other hand there was no significant relationship between the frequency of sepsis and the type of sex, mode of delivery, presence of jaundice or presence of GIT symptoms.

The frequency of neonatal sepsis was significantly higher if mothers had intrapartum fever or premature rupture of membranes. Also, the frequency of sepsis was significantly higher among neonates born to mothers in whom more than three vaginal examination were performed after rupture of membranes. On the other hand urinary tract infection or foul smelling liquor did not significantly affect the frequency of neonatal sepsis.

Lower gestational age, lower birth weight, lower total leukocyte count, higher immature to total leukocyte (I /T) ratio, higher sepsis score or higher values of CRP was each risk factor of mortality. On the other hand, the mortality was not significantly related to the neutrophil count