Elevated C‐reactive protein in umbilical cord blood: Neonatal case review

• Published in: Pediatrics international Vol. 61; no. 6; pp. 583 - 586
• Main Authors: Kitano, Taito, Takagi, Kumiko, Arai, Ikuyo, Yasuhara, Hajime, Ebisu, Reiko, Ohgitani, Ayako, Minowa, Hideki
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.06.2019
• Subjects: Antimicrobial agents; Bacteremia; Bacteremia - blood; Bacteremia - diagnosis; Birth; C-Reactive Protein - metabolism; Chorioamnionitis; Cord blood; C‐reactive protein; Disease Progression; early onset sepsis; Female; Fetal Blood - metabolism; Health care facilities; Humans; Infant, Newborn; Logistic Models; Male; Multivariate Analysis; Neonatal Sepsis - blood; Neonatal Sepsis - diagnosis; neonate; Neonates; Pediatrics; Placenta; Prognosis; Regression analysis; Retrospective Studies; Sepsis; Umbilical cord; early onset sepsis; neonate; C-reactive protein; chorioamnionitis; umbilical cord
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1111/ped.13866

Background C‐reactive protein (CRP) has limited placental transportability. Relying on CRP level in umbilical cord blood alone is an inaccurate way to predict early onset neonatal sepsis, and we retrospectively reviewed the clinical courses of neonates with elevated CRP in umbilical cord blood. Methods This study was a retrospective case review of neonates with elevated CRP in umbilical cord blood (>0.5 mg/dL) in the Nara Prefecture General Medical Center, Nara, Japan between February 2013 and August 2017. We investigated the association of maternal and neonatal factors with neonatal clinical course. Then, we compared the cases of neonates with and without elevated CRP in umbilical cord blood. Results The subjects consisted of a total of 22 neonates with elevated CRP in umbilical cord blood and 344 neonates without elevated CRP in umbilical cord blood. Of the 22 neonates with elevated CRP, 18 had some symptoms of sepsis at birth, but the symptoms of 85% of the symptomatic patients resolved ≤24 h after birth. Two neonates with elevated CRP in umbilical cord blood had bacteremia, and they had poor prognoses. Elevated CRP in umbilical cord blood was associated with length of antimicrobials (P = 0.021), immature/total neutrophil ratio (P = 0.017), and pathological chorioamnionitis (CAM; P = 0.028) on multivariable logistic regression analysis. Conclusion Elevated CRP in umbilical cord blood was associated with pathological CAM. Most symptoms of sepsis resolved <24 h after birth.