Role of C-Reactive Protein and Immature to Total Neutrophil Ratio in Early Onset Neonatal Sepsis

Introduction: Neonatal septicaemia is a significant cause of morbidity and mortality in newborn infants. It often presents a diagnostic challenge in the resource poor setting of most developing countries. Aim: 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. Materials and Methods: This prospective observational study included all term and preterm babies inborn and out born 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 >25,000/<5000, I/T ratio >0.2 and CRP positive (>0.6 mg/dL). Sepsis screen was considered positive for two or more positive tests. Blood culture was used as gold standard. The statistical analysis was done by Chi-square, Fisher’s exact and ANOVA tests using SPSS 20.0 version. Results: 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 I/T ratio showed positive correlation with blood culture (p-value 0.016). Conclusion: Sepsis screen in neonates is required for detection of infection as blood culture may be negative and even positive result takes few hours. C-reactive protein showed high sensitivity while I/T ratio was found to be highly specific.