Usefulness of C-reactive Protein in Diagnosis of Intrapartum and Postpartum Neonatal Sepsis

To determine effects of intrapartum risk factors for early onset sepsis (EOS) on CRP levels in neonates and to assess the suitability of this test in diagnosing EOS. Design: Cohort study. Setting: Labour and post natal wards in a pediatric and obstetric department at military hospital in Zarka. Subjects: 200 neonates at risk of developing infection. Methods: CRP levels in cord blood and neonatal blood at 24 hours were estimated using commercial kits. Babies were observed for signs of sepsis for at least 48 hours. Results: Seven (3.5%) neonates had elevated CRP levels in the cord blood. At 24 hours, 82 (41%) babies had elevated levels. Elevated cord CRP levels were significantly associated with rupture of membranes for 24 hours labour more than 12 hours and maternal fever. At 24 hours, elevated CRP levels were associated with primiparity, more than three vaginal examinations after membrane rupture, meconium staining of amniotic fluid and amnioinfusion. Ten (4%) of babies developed EOS. The negative predictive value for elevated CRP levels at 24 hours was 99%. Conclusion: Several intrapartum risk factors for EOS can cause elevation in CRP levels. However, this test may be useful in excluding infection.