Role of C-Reactive Protein and Immature to Total Neutrophil
Neonatal sepsis is an inflammatory response to bacteremia occurring during the first month of life and it remains a big problem in developing countries. Septicemia in newborns is a systemic inflammatory reaction to local infection that may lead to the development of more serious conditions. a study was conducted to determine the efficacy of C-Reactive Protein (CRP) and Immature Neutrophil Count (INC) to Total Neutrophil Count (TNC) ratio (I/T ratio) in the early diagnosis of neonatal sepsis.

This prospective observational study included all term and preterm babies inborn and outborn referred cases. The babies less than seven days of age with clinical symptoms and signs of suspected neonatal sepsis were included. Significant values for screening tests were taken as Total Leucocyte Count (TLC) of more than 25,000/less than 5000, I/T ratio more than 0.2, and CRP positive (more than0.6 mg/dL). The sepsis screen was considered positive for two or more positive tests. Blood culture was used as the gold standard. The statistical analysis was done by Chi-square, Fisher’s exact, and ANOVA tests using SPSS 20.0 version.

A total number of 60 subjects were included in the study with 45 (75%) as outborn neonates. Most of the neonates presented with tachypnea 27 (45%), 11(18.3%) with difficulty in feeding, and 10 (16.7 %) with lethargy. Significant p-values were observed using CRP and ITR as independent sepsis screening markers. The combination of CRP with the I/T ratio showed a positive correlation with blood culture (p-value 0.016).

Sepsis screen in neonates is required for detection of infection as blood culture may be negative and even positive result takes few hours. The C-reactive protein showed high sensitivity while the I/T ratio was found to be highly specific.
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