CRP LEVELS IN NEONATES: A COMPREHENSIVE ANALYSIS OF DIAGNOSTIC ACCURACY AND CLINICAL IMPLICATIONS.

Background: Neonatal sepsis is the third-leading cause of death and disability in the first month following delivery. Due to non-specific and inconclusive symptoms in early neonatal sepsis and bacterial culture (that is used as the gold standard) taking time, the diagnosis of early-onset sepsis (EOS) is challenging. Serum C-reactive protein (CRP) increase is a frequent inflammatory measure being studied for its diagnostic accuracy in neonatal sepsis. But challenges still exist, driven by various sensitivities and specificities determined by the kind of pathogen, reference values, and patient gestational and chronological age. Material and methods: Relevant retrospective clinical studies were carefully reviewed, and comprehensive analysis aimed to discern common ground and supporting ideas between them. The sequential CRP levels (each infant had at least 3 measurements) were recorded at different intervals after birth within the first 72 hours of age. The methodology and objectives of these studies were similar Results: The dynamics of C-reactive protein (CRP) levels were investigated in one of the studies involving 145 infants who met the inclusion criteria, 25% of whom were preterm. Particularly, at 12--24--36 and 48 hours, term babies had higher CRP levels than preterm babies. These levels peaked at 24 hours, then declined at 36 hours and settled by 48 hours. There was a substantial increase in the median CRP readings in the term group at all time points when compared to the preterm infants. Another study included 863 newborns, of which 179 term and 353 preterm babies met the inclusion criteria. In this study, preterm newborns had lower median CRP values in the group of EOS-positive (9 vs. 18.5 mg/L) and EOS negative infants (0.5 vs. 2 mg/L). Furthermore, it was noted that CRP levels were also increased in neonates with meconium aspiration syndrome (MAS) in term, severe respiratory distress syndrome, and the administration of surfactant in preterm newborns. We included another study to reiterate the above findings. In a retrospective cross-sectional study of 872 neonates, CRP levels higher than 8 mg/L were recorded when neonates were exposed to premature rupture of membrane (PROM), maternal autoimmune diseases, and MAS, and significantly lower when newborns were exposed to antenatal steroids, placenta previa, Intrahepatic cholestasis of pregnancy (ICP), and caesarean delivery. Conclusions: When comparing the median CRP values at different time intervals within the 72-hour period, we found that the median CRP values recorded in EOS-diagnosed preterm newborns were lower than those of EOS- diagnosed term newborns. Other non-infectious factors that contribute to elevated CRP levels include the administration of surfactant, MAS, PROM, and maternal autoimmune diseases. We now also know that, for instance, a caesarean delivery may show a lower-than-expected CRP level. This temporal profile reveals a unique CRP response in term and pre-term newborns, emphasizing the significance of taking these differences to heart while making clinical judgments. Ongoing efforts to refine gestational age-specific reference values for CRP are pivotal for enhancing its reliability in neonatal care. [ABSTRACT FROM AUTHOR]