Diagnostic Markers for Neonatal Sepsis: Comparing C‐reactive Protein, Interleukin‐6 and Immunoglobulin M

Abstract

This clinical study was conducted to evaluate the diagnostic value of C‐reactive protein (CRP), interlekin‐6 (IL‐6) and immunoglobulin M (IgM) in the early diagnosis of neonatal sepsis. The diagnostic values of each marker separately or in combinations were evaluated. The optimal cut‐off values of each marker in the diagnosis of neonatal sepsis were defined. Between December 2004 and March 2005, a total of 78 neonates at different ages with different diagnoses in a neonatal intensive care unit in North Jordan were enrolled. Patients were classified into ‘sepsis’ group, ‘probable sepsis’ group and ‘no sepsis’ group. Blood samples were collected for CRP, IL‐6 and IgM determination. A CRP value of 5 mg/l was the best among the three parameters with 95% sensitivity and 98% negative predictive value. Combination between parameters was helpful in enhancing the ability to diagnose sepsis. The best combination was CRP ≥ 5 mg/l and/or IgM of ≥20 mg/dl. We conclude that CRP, IL‐6 and IgM are helpful in the early diagnosis of Gram‐negative neonatal sepsis. However, CRP continues to be the best single test. The use of both CRP and IgM in combination was the most helpful in predicting Gram‐negative neonatal sepsis. We speculate a significant role of this combination in making decisions regarding antibiotics treatment and upgrading the level of medical care and observation in a setting where Gram‐negative micro‐organisms are causing the majority of neonatal infections.

Role of Sepsis Screening in Early Diagnosis of Neonatal Sepsis

“…In sepsis proven cases, 28(73.7%) were males. Similar findings as elicited in our study were cited by Mohammad f. Ibraheem [16] ,M Khassawne et al [17] stating male infants are more likely to develop sepsis than females. Gestational age: In present study, 92.1 % of the cases of sepsis proven and 82.3% of sepsis probable cases had full term as gestational age.…”

Presepsin as an Early Reliable Diagnostic and Prognostic Marker of Neonatal Sepsis.

“…Khassawneh M et al [20] reported that a CRP level >4 mg/L gave the best derived cutoff value with 95.7% sensitivity, 88.9% specificity, 78.6% PPV, and 98% NPV.…”

Proadrenomedullin as a prognostic marker in neonatal sepsis

“…Several acute-phase reactants such as C-reactive protein (CRP) and interleukin-6 (IL-6) have proven helpful in the diagnosis of an ongoing infection. However, the rate at which each marker begins to show elevations and the time to normalization differs with each marker (3)(4)(5)(6)(7).…”