A study to correlate biochemical markers - crp, procalcitonin and blood culture in neonatal sepsis with reference to bacteriological profile and antibiotic sensitivity pattern.

Abstract

Background- Neonatal septicemia is defined as generalized systemic features of infection, associated with pure growth of bacteria from one or more sites, in a newborn. It is one of the most important causes of mortality and morbidity in newborn (especially in preterm, Low Birth Weight babies).

Incidence of neonatal sepsis is about 30 per 1000 live births -incidence of mortality due to NNS is about 4.1 %.

Materials and Methods-The study was conducted in Mamata Academy of Medical Sciences, Hyderabad. 400 neonates admitted to NICU of the institute were included in the study. They were evaluated for any correlation between C Reactive Protien, Serum Procalcitonin levels, blood culture, WBC count, platelet count to see for any correlation to the prognosis.

Results- Among the 400 neonates suspected with sepsis, 306 (76.5%) had early onset and 94 (23.5%) had late onset. The blood culture isolation rate was 30.5% (n=122). The culture proven sepsis was seen more in Early Onset Sepsis 85.2% (n=104) than Late Onset Sepsis 14.7% (n=18). Altered WBC counts (<5000 or >20000 cells/cu.mm) were noticed in 62 neonates among which 18 of them had culture proven sepsis. Reduced platelet counts (1,50,000/cu.mm) were noticed in 192 neonates and culture positivity was seen in 23 of them. C-reactive protein was positive in 174 neonates (43.5%) of

which 78 neonates had culture proven sepsis. Elevated Procalcitonin levels (>0.5ng/ml) were found in 148 (37%) neonates among which 106 (71.6%) of them had culture proven sepsis.

Conclusion- Procalcitonin was found to be a sensitive tool for early diagnosis and predicting the outcome of sepsis when   compared to CRP. But it is    neither    100%    sensitive nor 100% specific to be relied as a sole marker. The greatest predictability can be achieved by the combination of assays rather than a single biomarker and as of now culture remains the gold standard in diagnosing sepsis.