Targeting Asymptomatic Term and Late Preterm Newborns at Risk for Early Sepsis: C Reactive Protein 20mg/L Threshold

Identification of sepsis is a major issue due to limitations in diagnosis and severity of outcome. Different combinations of tests are used to screen babies at risk for infection, none specific enough to avoid treatment of noninfected newborns. 193 newborns with 35 weeks of gestational age admitted in the maternity were screened for infection using a protocol scoring system involving haematological values and CRP 10mg/l. Blood-cultures were taken after treatment decision, before antibiotics were started. No microbiological exam was included in the screening. Treatment decisions were taken by the staff irrespectively of the ongoing observational study. Newborns were classified by the authors in 4 groups: infected (culture verified), strongly suspected infection (SSI), no sepsis but treated (NST), no sepsis-no treatment (NSNT). Treatment decision was revaluated by the authors according to different cut-off levels of CRP. 40 newborns (20.7%) received antibiotics. 2 had positive blood-cultures. 13 were classified as SSI (all treated) and 178 as not infected (25 treated). All infected babies were identified but the error of the positive predictive value reached 62.5%. Revaluation of treatment decisions with CRP cut-off levels of 15, 20 and 25 mg/l showed respectively 60.5%, 51.6 and 48% of error of the positive predictive value, the first two cut-offs missing no infected newborns but the last one missing two. A new scoring system including CRP at 20mg/l has been in use since then without readmissions for infection and an estimated reduction of 24% antibiotic treatment.