Assessment of C-Reactive Protein in the Early Diagnosis of Neonatal Sepsis in a Rural Area in Tikrit

Abstract

Background: In most of the cases of neonatal sepsis the diagnosis is delayed until late stages of the diseases & end often in complications & death. The late diagnosis is due to the fact that the early signs are neither specific nor sensitive. The problem of delayed diagnosis and treatment is more prevalent & much longer in rural areas which are away from health care  facilities.  Recently,  reliable  &  early  diagnosis  of  neonatal  sepsis  has  become  a challenging topic in the medical discussion. The gold standard test for neonatal sepsis is the blood culture. However, blood culture is restricted by the drawback of false negative results & time-consuming investigation. C-reactive protein (CRP), a pentraxin protein, plays an essential job in inflammatory and/or infectious stimuli, thus being considered as an acute- phase protein in neonatal sepsis. Because the early diagnostic value of CRP is still a matter of debate when used for the diagnosis of neonatal sepsis. The aim of this study is to evaluate the diagnostic value of CRP in early diagnosis of neonatal sepsis in rural area.  Patients & Methods: A cross sectional outpatient based research was carried out on 100 neonates suspected to have early sepsis examined in the private clinic in some rural areas in Al-Alam district. These rural areas in Iraq are away from health care services & the people suffer from poverty, so that the families can’t admit their sick children to hospital. Usually they want to treat their children at home on their own responsibility. This study is a necessity method for treating special conditions in exceptional circumstances that prevent them from following the approved medical rules, such as in-hospital treatment and using cheap, simple and rapid investigation. The period of the study was one year from 1  May 
st
2020 to 1st May 2021. The patient’s inclusion criteria were neonates of age less than 28 
days of life with manifestations of sepsis. The patient’s exclusion criteria were neonates 
with previous treatment with antibiotics, congenital anomalies or any other diseases other 
than sepsis. A questionnaire was developed and contained the clinical information about the 
patients. Detailed history was taken from each family which includes age, sex, maturity, 
residence, weight, risk factors and clinical presentations of neonatal sepsis. Investigations 
C-reactive protein was done for all neonates. These neonates received antibiotic therapy of 
combination  (Gentamicin  5mg/kg  plus  ampicillin  200  mg/kg)  or  (3   generation 
rd
cephalosporin 100mg/kg plus Ampicillin 200 mg/kg) based on the clinical examination and CRP result. Follow up carried out by clinical examination and serial CRP which done after 1 week.