Article ID: WMC001643 ISSN 2046-1690

Evaluation Of Serum C-reactive Protein In Diagnosis

And Prognosis Of Neonatal Septicemia
Corresponding Author:
Dr. Bipin Kumar,
Associate Professor, Pathology, IGMC&RI, Puducherry, 605009 - India

Submitting Author:
Dr. Bipin Kumar,
Associate Professor, Pathology, IGMC&RI, Puducherry, 605009 - India

Article ID: WMC001643

Article Type: Thesis
Submitted on:02-Jul-2013, 02:23:08 AM GMT Published on: 02-Jul-2013, 11:38:58 AM GMT
Article URL: http://www.webmedcentral.com/article_view/1643
Subject Categories:PAEDIATRICS
Keywords:Neonatal septicemia, C-reactive protein, blood culture, total leucocyte count, absolute neutrophil
count, band cell/ neutrophil count ratio
How to cite the article:Kumar B. Evaluation Of Serum C-reactive Protein In Diagnosis And Prognosis Of
Neonatal Septicemia. WebmedCentral PAEDIATRICS 2013;4(7):WMC001643
Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution
License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Source(s) of Funding:
No any source of funding

Competing Interests:
No any competing interest

WebmedCentral > Thesis Page 1 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM
Evaluation Of Serum C-reactive Protein In Diagnosis
And Prognosis Of Neonatal Septicemia
Author(s): Kumar B
Abstract
Background: Neonatal septicemia is an
overwhelming systemic infection due to gain access of
pathogenic bacteria in the blood stream of neonate.
C-reactive protein production is very early and
sensitive response to microbial infections and has
highest sensitivity, specificity and positive predictive
accuracy in cases of neonatal septicemia.
Methods: Total 50 clinically suspected cases and 25
healthy neonates as control were studied. Total WBC
count, absolute neutrophils count, Band
Cell/Neutrophil Count ratio, C-reactive protein
estimation, blood culture, culture of umbilical
discharge, other purulent material and urine were
done. CRP levels were noted on the day of admission
before instituting therapy and 5th and 10th day of
treatment.
Results: 22 cases were bacteriologically positive.
CRP was positive in 44 cases and one control.
Thirty-five cases were survived and 15 expired. CRP
value among survivors on 1st, 5th and 10th day was
18.51+/-4.21, 12.61+/-3.51 and 8.21+/-3.05
respectively; whereas, on 1 st and 5 th day among
expired was 23.22+/-2.42 and 21+/-3.21 respectively.
Mean CRP value on the 1st day and 10th day in cured
survivors was 17.89+/-4.52 and 6.0+/-7.0 (p value
Conclusion: Serum CRP estimation is very sensitive
and reliable method. Serial measurements of serum
CRP levels are useful in monitoring the course and it
provides an early indication of response of treatment.
It can help in decision of initiating or discontinuing
antibiotic therapy. The persistence or insignificant
decline of serum CRP with treatment signifies about
inadequate treatment or development of complications.
Key words: neonatal septicemia, C-reactive protein,
blood culture, total leucocyte count, absolute
neutrophil count, band cell/ neutrophil count ratio.
Introduction
Neonatal septicemia is an overwhelming systemic
infection due to gain access of pathogenic bacteria in
the blood stream of an infant upto the age of 28 days
of life1. The gold standard for diagnosis of neonatal
WebmedCentral > Thesis
septicemia is isolation of microorganism from blood
and site of infection. However, it is time-consuming
procedure, requires well-equipped laboratory, trained
personnel and success rate is merely 40-50%. Hence,
the diagnosis is missed or delayed. These factors
stress the need for some early diagnostic measures
with reasonable specificity and sensitivity. Therefore,
for early initiation of therapy, certain positive indirect
markers along with clinical diagnosis are essential. For
this purpose, total leukocyte count(TLC), absolute
neutrophils count(ANC), Band cell to total neutrophils
count (BC/NC) ratio, Micro-ESR and Acute phase
reactants like C-reactive protein(CRP), Alpha1-acid
glycoprotein and Alpha1-antitrypsin etc. have come in
procedure 2 . Among these tests, CRP has highest
sensitivity, specificity and positive predictive accuracy
in neonatal septicemia3.
Materials And Methods
The present study was done in the department of
Pathology and department of Microbiology of our
medical college hospital. Cases and controls were
selected from the department of Pediatrics and
Obstetrics respectively. Fifty clinically suspected cases
of septicemia comprised for study group and 25
healthy neonates served as control group. All the
cases were studied under following headings.
1. Laboratory Investigations:
A) Blood Examination:
a) TLC;
b) Differential leukocyte Count(DLC), ANC and
estimation of BC/NC ratio;
c) Culture and sensitivity(C/S) of blood;
d) CRP estimation on the day of admission, on the 5th
and 10th day of treatment.
B) C/S of umbilical discharge, pustules or abscess
when present.
C) Urine C/S as per requirement.
2. Procedures:
a) TLC: Capillary blood from free flowing heel prick
Page 2 of 18
WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM
was taken up. TLC was done with the help of
Haemocytometer.
b) DLC, ANC and BC/NC ratio: Blood smears were
made on clean glass slides, air dried and stained by
Leishman stain. The cells were examined under oil
immersion lens. The differential count was done in two
sets of 100 white blood cells. From the percentage of
cell type, the ANC per cmm was calculated. BC/NC
ratio was obtained after identifying the band cell in
peripheral smear. Band cells were identified by cells
with no lobulation for those in which the nucleus was
indented but isthmus between the lobes was wide
more than one third of the broadest segment.
The findings were classified as abnormal using
following criteria:
1. TLC <5,000/cmm.
2. ANC suggestive if counts were either < 1000/cmm
or >10,000/cmm.
3. BC/NC ratio >0.2.
b) Blood Culture:
Sampling Technique: 2ml of Blood samples were
obtained from the prominent vein by scalp vein set and
disposable syringe after taking aseptic precaution. It
was added to liquid glucose broth contained in a flask.
The flask was plugged and rotated to mix the blood
and broth thoroughly.
Culture: The flask was incubated at 37°c under
aerobic conditions. After 24 hrs, subcultures were
done. Depending upon the type of organism, it was
inoculated in a) Nutrient agar b) Blood agar c)
MacConkey medium d) Wilson Blair medium and
again incubated for 24hrs at 37°C.
c) Culture of umbilical discharge and other
purulent material: The samples for culture were
taken with sterilized cotton swab stick from the
affected site. After taking sample, stick was quickly
placed inside a sterilized autoclaved culture tube.
Culture was done on different media in usual manner.
d) Urine culture: The genitalia were cleaned with
savlon solution and mid stream urine was taken in
culture tube and inoculated as usual manner for C/S.
Identification of organism from culture: Types of
bacterial growth from culture were identified on the
basis of:
a) Morphology of colonies.
b) Type of staining reaction such as Gram positive or
negative.
c) Shape and other morphology of organism whether
WebmedCentral > Thesis
in pairs, chains or other groups.
d) Motility of organism- Whether motile or nonmotile.
Motile- E.coli, Proteus, Pseudomonas etc. Nonmotile-
Klebsiella, Shigella etc.
e) Growth of organism in a particular media- e.g.
Wilson and Blair media- Salmonella.
f) Type of hemolytic reaction in blood agar media e.g.
Beta hemolysis by Staphylococcus, group B
Streptococcus, Streptococcus fecalis etc.
g) Type of colony in MacConkey media- whether
lactose fermenter or nonfermenter. Lactose fermenter:
- produce bright pink colonies e.g. E.coli, Klebsiella etc.
Lactose nonfermenter- produce colorless colonies e.g.
Proteus, Pseudomonas, Salmonella, Shigella etc.
h) Different biochemical reactions such as-
1. Sugar fermentation.
2. Tests to differentiate among enterobactericae e.g.
indole production, Methyl red, Voges-Proskaeur
reaction and citrate utilization tests.
3. Some specific reactions for organisms e.g.
phosphate reaction- Staphylococcus aureus;
hydrolysis of hippuric acid- Group B Streptococcus;
deamination of phenyl alanine to phenylpyruvic acid-
Proteus; arginine hydrolase reaction- Pseudonymous,
Salmonella etc. pigment production- Pseudomonas;
Staphylococcus aureus. Antibiotic sensitivity was
determined by disc diffusion technique.
Estimation of serum CRP- CRP was estimated by
slide latex agglutination method. The reagents and
information regarding their use were provided in the kit
HUMAN'S HUMATAX CRP (German Product).
Principle-The CRP reagent had latex particles coated
with anti-human CRP antibody. When the reagent was
mixed with serum containing CRP at a level greater
than 6mg/L, the particles agglutinated. This was
interpreted as being positive sample. The reagent was
also used for the semi-quantification of CRP. For this
purpose the sample was diluted over a range of
dilutions and each was tested qualitatively. The CRP
level was estimated from the last dilution with visible
agglutination.
Sensitivity: Humatax was standardized to detect CRP
concentrations in non-diluted serum samples of
approximately 6mg/L or higher.
Contents, reagents and materials provided:
1. CRP latex reagent (blue) (white cap);
2. 1ml control serum positive (red cap);
3. 1ml control serum negative (green cap);
4. 1 slide with 6 cells. Reagent 1, 2 and 3 contained
0.095% sodium azide as a preservative.
Page 3 of 18
WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM
Stability: Latex reagent and control sera were stable
upto the expiry date when stored at 2-8°c.
Serum sample: 2 ml blood was obtained by
venipuncture into a sterile vial without anticoagulant. It
was allowed to clot at room temperature and after
complete clot retraction, serum was separated for
testing. The serum sample was stored in refrigerator at
2-8°c.
PROCEDURE: SLIDE TEST:
A] Qualitative determination (screening test): Latex
reagent, control and serum samples were brought to
room temperature. Mixed the latex reagent prior to use
to suspend the latex particle completely. Pipetted
reagent onto separate cells of the slide. Serum
sample- 40µL, control serum positive bottle-1 drop,
Control serum negative bottle- 1 drop, CRP latex
reagent- 1drop each into all samples and control cells
were applied. Mixed with separate sticks and
spreaded the fluid over the entire area of the particular
cells. Tilted the slide back and forth for 2 minutes so
that the mixture was rotated slowly. At the end of 2
minutes results were read.
Interpretation of results: Distinct agglutination
indicates a CRP content of more than 6mg/L in the
non-diluted specimen. Sera with positive results were
retested in the titration test.
B] Semiquantitative test: diluted the specimen with
glycine NaCl buffer. Positivity in 1:2, 1:3, 1:4, 1:5, 1:6,
1:7 and 1:8...... dilution equals to 12, 18, 24, 30, 36, 42
and 48..... mg/L of CRP value in undiluted sample.
Quality control: Positive and negative control sera
were used with each series. Their results were
compared with those of the unknown specimen to
distinguish possible granularity from agglutination. The
positive control showed a distinct agglutination within 2
minutes. The negative control showed a smooth
suspension without any visible agglutination after 2
minutes.
CRP level was noted in suspected cases on admission
before instituting therapy, on 5th day of the treatment
and 10th day of treatment.
Statistics: All the readings of CRP estimation were
recorded. The results were analyzed in relation to
culture positive cases of septicemia for sensitivity and
in relation to definitely sepsis negative cases for
specificity.
Results
Twenty-two cases were bacteriologically positive. Most
common isolated organism was Escherichia coli
WebmedCentral > Thesis
followed by Klebsiella pneumonae, Pseudomonas
aeruginosa, Staphylococcus aureus, Proteus mirabilis,
Group B Streptococcus and Streptococcus fecalis
(Table 2). CRP was positive in 44 cases and 1 control
(Table 3). Thirty-five cases were survived and 15
expired. CRP value among survivors on 1st, 5th and 10th
day was 18.51+/-4.21, 12.61+/-3.51 and 8.21+/-3.05
respectively; whereas, on 1 st and 5 th day among
expired was 23.22+/-2.42 and 21+/-3.21 respectively
(Table 4). Mean CRP value on the 1st day and 10th
day in cured survivors was 17.89+/-4.52 and 6.0+/-7.0
(p value <0.001) whereas in complicated cases among
survived was 24.00+/-7.0 and 16.21+/-4.21
respectively (Table 5). Leucopenia was found in 22
cases (Table 6). Absolute Neutrophil Count was
suggestive in 30 cases (Table 7). Band cell/ Neutrophil
count ratio was found abnormal in 34 cases (Table 8).
Sensitivity, Specificity and Positive predictive accuracy
of CRP; TLC; ANC; BC/NC ratio were 90.90%,
96.00%, 95.23%; 45.45, 100.00, 100.00; 63.63, 64.00,
60.68; 72.72, 68.00, 66.67 respectively (Table 9 and
Graph 1).
Discussion
Neonatal septicemia is very common in the present
Indian set-up. The disease has got high morbidity and
mortality but it is unfortunate that none of laboratory
parameters available till are rapid, specific, sensitive,
cheap and simple enough to confirm the diagnosis and
to asses the prognosis or therapeutic response in this
condition. The present work was concluded to assess
the efficacy and reliability of CRP in neonatal
septicemia and values of the CRP as a tool of
prognosis in neonatal septicemia. CRP production is
very early and sensitive response to most form of
microbial infections 4 . CRP is found in very low
concentration in the sera of healthy neonate 5 . Its
concentration raises upto 3,000 fold in response to
most forms of tissue damage, inflammatory conditions
and infections. It returns to its normal level when
inflammatory reaction subsides5. Fetus as early as 28
weeks of gestation have high concentration of CRP in
serum in response to variety of infections. It doesnot
crosses placenta. Its concentration in mother and fetus
are independent of each-other6. A good response to
antibiotics is indicated by rapid decline in level of CRP
whereas persistent elevation of serum CRP suggests
either the treatment is inadequate or some
complication have developed7. CRP has considerable
utility for predicting outcome in terms of survival or
complications8. Commonly used anti-inflammatory or
immunosuppressive drugs including steroids, unless
Page 4 of 18
WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM
these drugs affect actively of underlying diseases do
not affect the CRP response8. After 3 days of life, CRP
is the best single test in early detection of neonatal
septicemia8. Serial serum CRP estimation confirms the
diagnosis; monitor the course of infection and the
efficacy of antibiotic treatment 9 . In episodes of
neonatal septicemia, where, antibacterial treatment
fails, CRP levels are moderately elevated, the day
prior to treatment start and increased continuously
thereafter. Whereas, success of treatment is generally
accompanied by a decline in CRP within four days10.
Serum CRP evaluation by semiquantitative latex
agglutination technique is quite rapid, giving result in
2-4 minutes, reliable, cheap and doesnot require a big
sophisticated laboratory, rather it can be done in small
laboratory.
A large number of methods are available for the
determination of CRP in the serum. Although,
electroimmunoprecipitation assay, immunometric
assay and laser nephelometry are sensitive and
quantitative method for the estimation of CRP. The
facilities for such specialized investigations are not
available at all centres 4 . In their absence, latex
agglutination method is quiet sensitive, quick and
semiquantitative method for CRP determination12,13. In
the present study serum CRP was done by rapid slide
latex agglutination method semiquantitatively and the
concentration of 6 mg/L or more was considered as
positive similar to other study14. 25 healthy neonates
as a control group were selected. The result of the test
showed that the serum was positive for CRP in only 4
% of the control cases, which was followed up for a
period of 4 weeks and not showed any infection.
Similar observation was made in other studies6,14,15.
22(44%) cases were found culture positive and
28(56%) negative. These findings correlated with the
findings of other studies 16,17,18 . However higher
percentage of positive cases were also observed19,20,21.
In the present study, Gram negative organisms were
found in 77.27% cases. Escherichia coli was the
commonest organism isolated, followed by Klebsiella
pneumonae, Staphylococcus aureus, Pseudomonas
aeruginosa, Proteus mirabilis, Group B Streptococcus
and Streptococcus fecalis similar to other study 19.
However, Klebsiella pneumonae or Staphylococcus
aureus was isolated as the most common organism in
other studies8,21,22. This variation in bacteriological
profile may be related with local preponderance of the
pathogens. The cases in study group were divided
based on clinical features and cultures into two groups.
Group 1 or definitely infected group considered of
22(44%) neonates with positive culture and group 2 or
probable case group consisted of 28(56%) neonates
with negative culture. 15(30%) expired and 35(70%)
WebmedCentral > Thesis
survived after treatment, similar to other study22. The
CRP was estimated on the day of admission before
the start of therapy and repeated on the fifth day and
tenth day of therapy. It couldnot be done on fifth and
tenth day in some babies, as they expired. Serum
CRP was positive in 44(88%) cases in study group on
the day of admission before the beginning of therapy.
The result of the test was highly significant as
compared to the control group. Increased serum CRP
was found in 75-95% cases in different studies6,7,16,21.
On the other hand, even less positivity of 37% in early
onset and 67% in late onset septicemia was also
found23. Mean value of CRP in the present study group
was 20.31+/-4.27% on the first day. This finding
reinforce the different study where mean value of
serum CRP was 15.75+/-12µg/ml in blood culture
positive and 6.13+/-11.72µg/ml in culture negative
cases 16 . The mean CRP values in positive cases,
which survived and expired, were 18.51+/-4.21 and
23.22+/-2.42mg/L, 12.61+/-mg/L and 21+/-3.21mg/L
on the 1st and 5th day respectively. On the 10th day it
was found 8.21+/-3.05 in neonates who survived. After
that, CRP was positive only in 17 out of 35 survived
cases. It was observed that initial value of CRP were
just significantly different (P<0.02) in both survived
and expired groups similar to other study 15 . With
therapy CRP decreased in both survived and expired
group on 5th and 10th day recording, but, fall was
highly significant (P<0.001). Clinical improvement was
noted in all cases where CRP had becoming negative.
The above observations made, confirm the utility of
CRP as a laboratory diagnostic and prognostic tool in
following the course of neonatal septicemia. A good
response of treatment was assessed by rapid fall in
CRP level whereas insignificant rise of CRP
suggested that either the treatment was inadequate or
some complications had developed. Similar
observations was made in different study, in which
maximum level of CRP reached within one to two days
of onset of infection and disappeared after one to two
days of recovery24. Serial determination of CRP was
found useful in monitoring the course of pyogenic
infections25. CRP levels, which didnot fall to normal
within 7-10 days, remained elevated or increased
again were usually a warning sign of a complications.
Significant decline of CRP was found as early as 3rd
day among survivors but not among those who
expired15.
Out of 35 cured cases, six developed complications.
They were not responded well to treatment. First day
mean CRP levels among the complicated patients
were significantly higher than those who got clinically
cure. In cured patients it was 17.89+/-4.52mg/L while
in complicated patients it was 24.00+/-7.0mg/L.
Page 5 of 18
WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM
Similarly in the third reading on 10th day decline was
much more in cured patients than in complicated
patients. Similar to our observations was found by
other workers7,10,15,25. Sensitivity, specificity and positive
predictive accuracy of CRP were assessed. For
comparison the sensitivity of total leukocyte count
(TLC), absolute neutrophil count (ANC) and band
cell/neutrophil count (BC/NC) ratio were also assessed.
Sensitivity, specificity and positive predictive accuracy
for CRP were 90.90%, 96.00 and 95.23% respectively;
while for TLC, ANC and BC/NC ratio they were
markedly less. Total leukocyte count (leucopenia)
gave indication of infection in 44% of cases while no
leucopenia was found in control group. Absolute
neutrophil count was suggestive in 60% in study group
and 36% in control group. BC/NC ratio> 0.2 was
present in 68% and 32% in study group and control
group respectively. TLC in 71.9% and BC/NC ratio in
69.4% of cases were found suggestive by others26.
Immature to Total (I/T) ratio was found very sensitive
indicator (71%) 23 . Sensitivity and specificity of
leucopenia with I/T ratio was found 67%/90% and
78%/73% in first 3 day which was good parameter,
and after 3 days 84%/66% and 79%/47% 9 .
Leucopenia and BC/NC ratio more useful than CRP
were also suggested27. Use of CRP for differentiation
between positive and contaminated blood cultures in
children and as better predictor than WBC or ANC
were also proposed28. However, both CRP and WBC
were found useful for the diagnosis of late neonatal
sepsis and accuracy increased when CRP and WBC
were combined and sequential CRP assay results
were used29.
Conclusion
Serum CRP is very sensitive and reliable method for
septicemia in neonates. Serial measurements of
serum CRP levels are useful in monitoring the course
of neonatal septicemia. It provides an early indication
of response of treatment. It can help in decision of
initiating or discontinuing antibiotic therapy. The
persistence or insignificant decline of serum CRP with
treatment signifies about inadequate treatment or
development of complications.
Acknowledgements
I acknowledge Dr (Prof) Basanti Verma, former head
of the department of Pathology and Dr. R. K.
Mahapatra, former head of the department of
microbiology, Darbhanga Medical College,
WebmedCentral > Thesis
Laheriasarai for their guidance during the study.
References
1. Stall BJ. Infection of the neonatal infant. In:
Kliegman RM, Behrman RE, Jenson HB, Stanton BF.
Nelson Text Book of Pediatrics. 18th ed. W. B.
Saunders Company. An imprint of Elsevier Science;
2007:p.794.
2. Singh M. The traditional health practices for care of
newborn babies. Swasth Hind. 1991;35:246-8.
3. Ramji S. Rapid diagnosis of neonatal septicemia.Ind
Pediatr. 1989;26:111-3.
4. PepysMB. C-reactive protein fifty years on. Lancet.
1981;21:653-6.
5. Hindocha P,CampbellCA, Gould JDM,
Wojciechowski A, Wood CBS. Serial study of
C-reactive protein in neonatal septicaemia. Arch Dis
Child 1984; 59:435-8.
6. Sabel KG, Wadsworth C. C-reactive protein (CRP)
in early diagnosis of neonatal septicemia. Acta
Paediatr Scand 1979; 68:825-31.
7. Sann L. Acute phase protein for diagnosis and
follow-up of neonatal infections.IndJ Pediatr.
1986;53:8-10.
8. Suri M, Thirupuram S, Sharma VK. Diagnostic and
prognostic utility of C-reactive protein,
alpha-1-antitrypsin and alpha-2-macroglobulin in
neonatal sepsis: a comparative account.IndPediatr.
28:1159-64.
9. Berger C, Uehlinger J, Ghelfi D, Blau N, Francini S.
Comparison of C-reactive protein and white blood cell
count with differential in neonates at risk for
septicemia. Eur J Pediatr. 1995;154:138-44.
10. Ronnestad A, Abrahamsen TG, Gaustad P, Finne
PH. C-reactive protein (CRP) pattern in neonatal
septicemia. APMIS. 1999;107:593-600.
11. Shortland DB, MacFadyen U, Elston A, Harrison G.
Evaluation of C-reactive protein values in neonatal
sepsis. J Perinat Med 1990; 18:157-61.
12. Singer JM, Plotz CM, Pader E,ElsterSK.The latex
fixation test.III. Agglutination test for C-reactive protein
and comparison with the capillary precipitin method.
Am J Clin Path. 1957;28:611-7.
13. Mccarthy PL, Fank AL. Ablow RC. Value of
C-reactive protein test in the differentiation of bacterial
and viral pneumonia.IndPediatr. 1978;92:554-6.
14. Kalra K, Sunder S, Ethence SR, Dayal RS.
C-reactive protein in neonatal infections.IndPediatr.
1985;22:215.
15. Ali SM, Chandra J, Ahmad P, Ahmad KN, Agrawal
M. Prognostic value of m-ESR and CRP in neonatal
septicemia. Ind. Pediatr.1988;25:864-6.
Page 6 of 18
WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

16. Adhikari M, Coovadia HM, Coovadia YM, Smit SY,

Moosa A. Predictive value of C-reactive protein in
neonatal septicaemia. Ann Trop Paediatr 1986;
6:37-40.
17. Chandana A, Rao MN, Srinivas M, Shyamala S.
Rapid diagnostic tests in neonatal septicemia. J
Pediatr. 1988;55:947-53.
18. Guha DK, Jaspal D, Krishna Das MS. Outcome of
neonatal septicemia. Clinical and bacteriological
profile.IndPediatr. 1978;15:423-7.
19. NamdeoUK, Singh HP, Rajput VJ, Kushwaha JS.
Hematological indices for early diagnosis of neonatal
septicemia.IndPediatr. 1985;22:287-92.
20. Chaturvedi P, Agrawal M, Narang P. Analysis of
blood-culture isolates from neonates of a rural
hospital.IndPediatr. 1989;26:460-5.
21. Mathers NJ, Pohlandt F. Diagnostic audit of
C-reactive protein in neonatal infection. Eur J Pediatr
1987; 146:147-51.
22. Parida SN, Verma IC,SinghMB, Thomas S.
Evaluation of micro erytherocyte sedimentation rate in
the diagnosis of neonatal sepsis.IndJ Pediatr.
1980;47:381-5.
23. Tegtmeyer FK, Horn C, Richter A, Vanwees J.
Elastase 1 proteinase inhibitor complex, granulocyte
count, ratio of immature to total granulocyte count and
C-reactive protein in neonatal septicemia. Eur J
Pediatr. 1992;151:353-6.
24. Sabel KG,Hanson LA.The clinical usefulness of
C-reactive protein (CRP) in early diagnosis of neonatal
infection. Acta Pediatr Scand. 1974;63:381.
25. Peltola HO. C-reactive protein for rapid monitoring
of infections of the central nervous system. Lancet.
1982;1:980-3.
26. Philips AGS, Hewitt JE. Early diagnosis of
neonatal sepsis. Pediatr. 1980;65:1036-41.
27. Baptista-Gonzalez, Ibarra-Camacho A, Cedillo RE,
Torres-Allipi BI. Usefulness of C-reactive protein for
the diagnosis of neonatal sepsis. Bol Med Hosp Infant
Mex. 1989;46:824.
28. Ron Shaoul1ADEF, Avishai
Lahad1BC,AdaTamir2C, Amos Lanir3B, Issac
Srugo1,4A. C Reactive Protein (CRP) as a predictor
for true bacteremia in children. Med Sci Monit, 2008;
14: 255-261. 29. Caldas JP, Marba ST, Blotta MH,
Calil R, Morais SS, Oliveira RT. Accuracy of white
blood cell count, C-reactive protein, interleukin-6 and
tumor necrosis factor alpha for diagnosing late
neonatal sepsis. J Pediatr. 2008;84:536-42.

WebmedCentral > Thesis Page 7 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustrations
Illustration 1

Table 1: Bacteriological profile in cases with its classification

Features and classification of cases number %

Bacteriologically -ve – Probable case 28 56

Bacteriologically +ve Positive in blood 16 32

(44%)-- Confirmed cases Positive in urine 4 8

Positive in umbilical discharge 1 2

Positive in other purulent discharge 1 2

WebmedCentral > Thesis Page 8 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 2

Table 2: Bacteriological profile in culture positive case

Organism Number of cases %

(n=22)

Gram negative Escherichia coli 7 31.81

(77.37%)
Klebsiella pneumonae 6 27.37

Pseudomonas aeruginosa 3 13.64

Proteus mirabilis 1 4.55

Gram positive Staphylococcus aureus 3 13.63

(22.73%)
Group B Sreptococcus 1 4.55

Strptococcus fecalis 1 4.55

WebmedCentral > Thesis Page 9 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 3

Table 3: Serum CRP profile in controls and cases

CRP Profile Control group Study group

Number % Number % CRP level(mg/L), 95th percentile

mean+/- S.D

CRP+ve 1 4 44 88 20.31+/-4.27 28.8

CRP-ve 24 96 6 12 - -

WebmedCentral > Thesis Page 10 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 4

Table 4: Serial estimation of CRP in survivors and expired neonates

Group CRP Profile CRP value mean+/-S.D

1st day (before 5th day (of treatment) 10th day (of treatment)
treatment)

Survivors CRP+ve (n=29) 18.51+/-4.21* 12.61+/-3.51** (n=29) 8.21+/-3.05*** (n=17)

CRP-ve (n=6) (n=35) (n=6) (n=18)

Expired CRP+ve (n=15) 23.22+/-2.42 (n=15) 21+/-3.21 (n=11); 4

patient expired

CRP-ve (n=0)

P value:

*/** <.001 highly significant

*/*** <.001 highly significant

WebmedCentral > Thesis Page 11 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 5

Table 5: Comparison of 1st reading and 3rd reading in cases with complications among survivors.

First reading on 1st day Third reading on 10th day

Cured (n=29) With complications (n=6) Cured (n=29) With complications (n=6)

CRP mean+/-S.D 17.89+/-4.52* 24.00+/-7.0** 6.00+/-7.0 16.21+/-4.21

(mg/L) (n=11)

WebmedCentral > Thesis Page 12 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 6

Table 6: Total leukocyte count profile of the study and control group

Leucopenia Normal count

Number % Number %

Study group 22 44 28 56

Control group 0 0 25 100

WebmedCentral > Thesis Page 13 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 7

Table 7: Absolute neutrophil count profile in cases and control group

Suggestive Not suggestive

Number % Number %

Study group 30 60 20 40

Control group 9 36 16 64

WebmedCentral > Thesis Page 14 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 8

Table 8: Band cell- Neutrophil count (BC/NC) ratio profile in cases and controls

Ratio>0.2 Ratio<0.2

Number % Number %

Study group (n=50) 34 68 16 32

Control group (n=25) 8 32 17 68

WebmedCentral > Thesis Page 15 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 9

Table 9: Sensitivity, specificity and positive predictive accuracy of individual test

Total positive Positive test with Positive predictive

test proven sepsis Sensitivity specificity accuracy

CRP 21 20 90.9 96 95.23

TLC 10 10 45.45 100 100

ANC 23 14 63.63 64 60.68

BC/NC ratio 24 16 72.72

WebmedCentral > Thesis Page 16 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Illustration 10

Graph 1: Sensitivity, specificity and positive predictive accuracy of individual test.

WebmedCentral > Thesis Page 17 of 18

WMC001643 Downloaded from http://www.webmedcentral.com on 04-Jul-2013, 04:13:18 AM

Disclaimer
This article has been downloaded from WebmedCentral. With our unique author driven post publication peer
review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is
completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript
but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before
submitting any information that requires obtaining a consent or approval from a third party. Authors should also
ensure not to submit any information which they do not have the copyright of or of which they have transferred
the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to
the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor
replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the
WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm
that you may suffer or inflict on a third person by following the contents of this website.

WebmedCentral > Thesis Page 18 of 18