**10. References**

54 Neonatal Bacterial Infection

threshold level. [23]

**9. Conclusion** 

dependent reference values.

**Author details** 

Wilhelm Müller

Bernhard Resch

*Graz, Austria* 

*Graz, Austria* 

Nora Hofer

*Austria* 

*Austria* 

Reliable reference values are crucial for obtaining an adequate diagnostic accuracy. Upper limits for CRP during the first days of life have mainly been established from uninfected but symptomatic neonates. The cut-off values reported in the literature range from 1,5mg/l to 20 mg/l with thus wide ranging sensitivities and specificities. [11, 63] The up to date most used upper limit for CRP during the first days of life of 10 mg/l has been established in 1987 by Mathers and Pohlandt. [28] One decade later, Benitz et al. evaluated CRP levels in 1002 episodes of suspected early onset sepsis and confirmed the value being an appropriate

Use of CRP in the first few days after birth is complicated by a nonspecific rise primarily related to the stress of delivery. [11, 45] This rise of CRP starts shortly after birth and peaks with 13 mg/l in term and 11 mg/l in preterm newborns during the second and third day of life, respectively. [44] These observations raise concern about the static cut-off value not reflecting the physiologic kinetics of CRP after birth. In view of the physiologic dynamics of CRP during the first days after birth and the influence of gestational age on its response to infection, it appears reasonable to reconsider this static cut-off value and evaluate the possible advantages of the introduction of dynamic reference values. However, the current literature lacks sufficient evidence to make recommendations for the use in clinical practice.

CRP is one of the most widely available, most studied, and most used laboratory tests for neonatal bacterial infection and despite the continuing emergence of new infection markers it still plays a central role in the diagnosis of early onset sepsis of the neonate. CRP has the advantage of being well characterized in numerous studies and the extensive knowledge on its properties and limitations makes it safer compared to other, newer markers. Still, further research is needed on the topics of the influence of gestational age on CRP kinetics in infection, non-infectious confounders, and the evaluation of dynamic and gestational age

*Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz,* 

*Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of* 

*Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz,* 

*Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of* 


[19] Kääpä P, Koistinen E. Maternal and neonatal C-reactive protein after interventions during delivery. Acta Obstetricia Et Gynecologica Scandinavica. 1993;72(7):543-6.

The Role of C-Reactive Protein in the Diagnosis of Neonatal Sepsis 57

[34] Berger C, Uehlinger J, Ghelfi D, Blau N, Fanconi S. Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia.

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**Chapter 5** 

© 2013 Cimenti et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Cimenti et al., licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**The Role of Immature Granulocyte Count** 

Christina Cimenti, Wolfgang Erwa, Wilhelm Müller and Bernhard Resch

Although diagnostic and therapeutic approaches to neonatal sepsis considerably progressed over the last decades, distinguishing infected from non-infected patients still remains a major challenge, especially in the early phase of disease when symptoms are often subtle and unspecific. Development and application of potent antibiotic medication and the advances in neonatal care could improve treatment but incidence of neonatal sepsis is still high. Compared to an incidence rate ranging from 1.5 to 3.5 per 1000 for neonatal early onset sepsis (EOS) and up to 6 per 1000 live births for late onset sepsis (LOS) in developed countries, the reported incidence of neonatal sepsis varies from 7.1 to 38 per 1000 live births in Asia and from 6.5 to 23 per 1000 live births in Africa (Vergnano et al., 2005). The physiologic immature state of the immune system and reduced levels of preformed maternal antibodies in preterm infants together with organ immaturity and a lower expression of major histocompatibility complex (MHC) class II antigens on monocytes contribute to a disturbed equilibrium of proand anti-inflammatory factors resulting in a reduced immune defence making the preterm infant more susceptible for sepsis and its short and long term complications (Azizia et al., 2012; Stoll et al., 2004). Prospective data collection of 16 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network revealed a declining incidence of blood culture proven EOS from 19.3 per 1000 in 1991-93 to 15.4 per 1000 live births in 1998-2000 among very low birth weight (VLBW) infants, whereas the incidence of late-onset septicemia was 22% and remained essentially unchanged over the observed period of time. However, the potentially life threatening character of EOS is reflected by high mortality rates reaching between 1.6% in nonblack term infants and 37% in preterm infants with VLBW (Fanaroff et al., 2007; Weston et al., 2011). Infants in this study without EOS showed a

**and Immature Myeloid Information** 

**in the Diagnosis of Neonatal Sepsis** 

Additional information is available at the end of the chapter

significantly reduced mortality risk of 13%.

http://dx.doi.org/10.5772/54531

**1. Introduction** 

