Comparative Study of Platelet count and C-Reactive Protein among Gram Positive, Gram Negative and Fungal Sepsis in Newborns
Keywords:
Platelet Count, C-reactive protein, Culture Positive Neonatal Sepsis
Abstract
Introduction: Septicemia is characterized by positive blood culture, thrombocytopenia & elevated C-reactive protein.
Objective: To compare platelet indices and CRP among gram-positive, gram negative and fungal sepsis in newborns.
Methods: This is a retrospective case analysis of 52 blood culture positive patients between January-2012 to December-2014. The parameters examined were Baseline Platelet Count, Change In Platelet Count, (Baseline Platelet count- Change in Platelet count)/ Baseline Platelet Count , Platelet nadir, incidence, duration & severity of Thrombocytopenia, baseline CRP, change in CRP, (baseline CRP- change in CRP)/ baseline CRP, CRP peak, incidence & duration of raised crp.
Statistical analysis: All data were collected in validated preformatted proforma sheet & analysed using appropriate statistical methods.
Results: Majority (61.53%) had gram negative sepsis. Klebsiella was the commonest organism & was isolated in 21.15% of babies. Weight of the baby (p= 0.014), CRP Peak (p= 0.034), incidence of high CRP (p = 0.003), duration of high CRP (p= 0.004) & duration of thrombocytopenia (p = 0.001) differed significantly among gram-positive, gram negative & fungal sepsis.
Conclusion: We noted higher rise in CRP with prolonged duration following Gram negative sepsis. However the incidence of both raised CRP and thrombocytopenia were more among fungal sepsis. Though the onset was delayed, lower platelet nadir, more severe thrombocytopenia with prolonged duration was noted among fungal sepsis.
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References
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30. Lakshmi N, Guru Raj Kumar A. C - reactive protein In Neonatal Sepsis. Journal of Indian Microbiology, 1992, 10(1): 29-31.
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32. Ahmed Z, Ghafoor T, Waqar T, Ali S, Aziz S, Mahmud S Diagnostic value of C- reactive protein and hematological parameters in neonatal sepsis. Journal of College of Physicians & Surgeons,Pakistan, 2005, 15 (3):152-156.
33. Blanco A, Solis G, Arranz E, Coto GD, Ramos A T. Serum levels of CD14 in neonatal sepsis by Gram-positive and Gram-negative bacteria. Acta Paediatrica, 2008, 85(6):728-732. [PubMed]
34. Nuutila J, Jalava-Karvinen P, Hohenthal U, Laitinen I . CRP/CD11b ratio: a novel parameter for detecting Gram-positive sepsis. Human Immunology Journal, 2009, 70(4):237-243. [PubMed]
35. Charoo BA, Iqbal JI, Iqbal Q, Mushtaq S, Bhat AW, Nawaz I.Nosocomial sepsis induced late onset thrombocytopenia in a neonatal tertiary care unit: a prospective study. Hematology Oncology Stem Cell Therapy Journal 2009; 2:349-53.
36. Rowe MI, Buckner DM, Newmark S. The early diagnosis of Gram negative septicemia in the pediatric surgical patient. Annals of Surgery. 1975;182:280–286. [PubMed]
37. Modanlou HD, Ortiz OB. Thrombocytopenia in neonatal infection. Clinical Pediatrics. 1981;20:402–407. [PubMed]
38. Storm W. Use of thrombocytopenia for the early identification of sepsis in critically ill newborns. Acta Paediatrica. 1982;23:349–355. [PubMed]
39. Escobar GJ. The neonatal "sepsis work-up" personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization; Pediatrics 1999; 103: 360-373.
40. Manzoni P, Mostert M, Galletto P, Gastaldo L. Is thrombocytopenia suggestive of organism-specific response in neonatal sepsis? Pediatrics 2009; 51:206-10. [PubMed]
41. Benjamin DK, Ross K, McKinney RE, Benjamin DK, Auten R, Fisher RG. When to suspect fungal infection in neonates: clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase negative staphylococcal bacteremia. Pediatrics. 2000; 106:712–718.
2. Van den Hof MC, Nicolaides KH. Platelet count in normal, small, and anemic fetuses. American Journal of Obstetrics & Gynecology.1990;162(3):735-9.
3.Sola-Visner M, Saxonhouse MA, Brown RE. Neonatal thrombocytopenia: what we do and don’t know. Early Human Development. 2008;84(8):499-506.
4. Sprung CL, Peduzzi PN, Shatney CH, Schein RM, Wilson MF, Sheagren JN, Hinshaw LB. Impact of encephalopathy on mortality in the sepsis syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group. Critical Care Medicine. 1990;18(8):801-6.
5. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Medicine. 1996;22(7):707-10.
6. McKenzie SB(1996a). Normal hematological values ; McKenzie.S B. Text book of haematology 2nd edition. Baltimore ;Williams & wilkins. [PubMed]
7. Chiesa C, Paner A, Osborn J. Diagnosis of neonatal sepsis : A clinical and laboratory challenge. Clinical Chemistry. 2004; 10: 279-287. [PubMed]
8. Franz AR, Kron M, Pohlandt F, Steinbach G. Comparison of procalcitonin with interleukin 8, C-reactive protein and differential white blood count for the early diagnosis of bacterial infections in newborn infants. Pediatric infectious disease Journal. 1999. 18, 666-671. [PubMed]
9. Pacifico L, Panero A, Colarizi P, Matrunola M, Simonetti AF, Chiesa C: Neonatal Candida albicans septic thrombosis of the portal vein followed by cavernous transformation of the vessel. Journal of Clinical Microbiology 2004, 42(9):4379-4382. [PubMed]
10. Nuntnarumit P, Pinkaew O, Kitiwanwanich S: Predictive values of serial C-reactive protein in neonatal sepsis. Journal of Medical Association Thailand 2002, 85 Supplement 4:S1151-1158. [PubMed]
11. Bipin K: Evaluation of serum C-reactive Protein in diagnosis and prognosis of neonatal septicemia. Paediatrics 2013, 4(7):WMC001643.
12. I Roberts, N A Murray. Neonatal thrombocytopenia: causes and management, Archives of Diseases of Childhood, Fetal Neonatal Edition 2003;88:F359-F364 doi:10.1136/fn.88.5.F359.
13. Haque KN. Neonatal Sepsis in the Very Low Birth Weight Preterm Infants: Part 2: Review of Definition, Diagnosis and Management. Journal of Medical Sciences. 2010;3(1):11-27.
14. Kyoung Hee Choi , Sung Soo Rim , Byung Min Moon ,Ki Bok Kim .Study on platelet counts and indices in neonates ; Korean Journal of Pediatrics 1996 March; 39(3) :338-345.
15. Mehmet Yekta Oncel, Ramazan Ozdemir, Sadik Yurttutan, Fuat Emre Canpolat, Omer Erdeve, Serife Suna Oguz, Nurdan Uras, Ugur Dilmen. Mean Platelet Volume in Neonatal Sepsis ; Journal of Clinical Laboratory Analysis 26: 493–496 (2012).
16. Abdalla Alshorman et al. The Effect of Neonatal Sepsis on Platelet Count and their Indices ; Journal of Medicine 2008; June: Vol. 42(2).
17. Jack D. Guida, Anette M. Kunig, Kathleen H. Leef, Steven E. McKenzie, David A. Paul. Platelet Count and Sepsis in Very Low Birth Weight Neonates: Is There an Organism-Specific Response? Pediatrics 2003; 111:1411–1415.
18. Stoll BJ, Hansen N, Fanaroff AA, Wright et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics, 2002, 110: 285-291.
19. Mhada TV, Fredrick F, Matee MI, Massawe A: Neonatal sepsis at Muhimbili National Hospital, Dar es Salaam, Tanzania; aetiology, antimicrobial sensitivity pattern and clinical outcome. BMC public health 2012, 12(1):904. [PubMed]
20. Viswanathan R SA, Ghosh C, Dasgupta S, Mukherjee S, Basu S: Profile of neonatal septicaemia at a district-level sick newborn care unit. Journal of health, population, and nutrition 2012 30(1):41-48. [PubMed]
21. Vallance H, Lockitch G: Rapid, semi-quantitative assay of C-reactive protein evaluated. Clinical Chemistry 1991, 37(11):1981-1982. [PubMed]
22. Sankar MJ AR, Deorari AK, Paul VK.: Sepsis in the newborn. Indian Journal of Pediatrics 2008,75(3): 261-266. [PubMed]
23. Qazi Iqbala b, Charoo Bashira, Sheikh Mushtaqa, Asif Ahmada and Akhtar Rasool Babaa. Thrombocytopenia and other hematological parameters in culture positive neonatal sepsis and their impact ; Journal of Pediatric Infectious Diseases 8 (2013) 25–29 25 DOI 10.3233/JPI-130371.
24. Deepa S, Manjunatha MR, Venkatesha D. Screening cord blood is a better diagnosing method for early onset neonatal septicemia; Indian Journal of Medical Research and Pharmaceutical Sciences, October 2014; 1(5) ISSN: 2349 – 5340.
25. Kayange N, Kamugisha E, Mwizamholya DL, Jeremiah S, Mshana SE: Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza-Tanzania. BMC pediatrics 2010, 10(1):39. [PubMed]
26. Kuruvilla KA, Pillai S, Jesudasan M, Jana AK. The bacterial profile of sepsis in a neonatal unit in south India. Indian Paediatrics 1998; 35:851-58. [PubMed]
27. Chiesa C, Signore F, Assumma M, Buffone E, Tramontozzi P, Osborn JF, Pacifico L. Serial measurements of C-reactive protein and interleukin-6 in the immediate postnatal period: reference intervals and analysis of maternal and perinatal confounders. Clinical Chemistry 2001, 47(6):1016-1022.
28. Hofer N, Zacharias E, Müller W, Resch B: An update on the use of C-reactive protein in early-onset neonatal sepsis. Neonatology 2012, 102(1):25-36. [PubMed]
29. Alexandraki I, Palacio C: Gram-negative versus Gram-positive bacteremia: what is more alarming?. Critical care (London, England) 2010, 14(3):161. [PubMed]
30. Lakshmi N, Guru Raj Kumar A. C - reactive protein In Neonatal Sepsis. Journal of Indian Microbiology, 1992, 10(1): 29-31.
31. Khassawneh M, Hayajneh WA, Kofahi H, Khader Y, Amarin Z, Daoud A. Diagnostic Markers for Neonatal Sepsis: Comparing C-reactive Protein, Interleukin-6 and Immunoglobulin M . Scandinavian Journal of Immunology, 2007, 65(2): 171-175.
32. Ahmed Z, Ghafoor T, Waqar T, Ali S, Aziz S, Mahmud S Diagnostic value of C- reactive protein and hematological parameters in neonatal sepsis. Journal of College of Physicians & Surgeons,Pakistan, 2005, 15 (3):152-156.
33. Blanco A, Solis G, Arranz E, Coto GD, Ramos A T. Serum levels of CD14 in neonatal sepsis by Gram-positive and Gram-negative bacteria. Acta Paediatrica, 2008, 85(6):728-732. [PubMed]
34. Nuutila J, Jalava-Karvinen P, Hohenthal U, Laitinen I . CRP/CD11b ratio: a novel parameter for detecting Gram-positive sepsis. Human Immunology Journal, 2009, 70(4):237-243. [PubMed]
35. Charoo BA, Iqbal JI, Iqbal Q, Mushtaq S, Bhat AW, Nawaz I.Nosocomial sepsis induced late onset thrombocytopenia in a neonatal tertiary care unit: a prospective study. Hematology Oncology Stem Cell Therapy Journal 2009; 2:349-53.
36. Rowe MI, Buckner DM, Newmark S. The early diagnosis of Gram negative septicemia in the pediatric surgical patient. Annals of Surgery. 1975;182:280–286. [PubMed]
37. Modanlou HD, Ortiz OB. Thrombocytopenia in neonatal infection. Clinical Pediatrics. 1981;20:402–407. [PubMed]
38. Storm W. Use of thrombocytopenia for the early identification of sepsis in critically ill newborns. Acta Paediatrica. 1982;23:349–355. [PubMed]
39. Escobar GJ. The neonatal "sepsis work-up" personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization; Pediatrics 1999; 103: 360-373.
40. Manzoni P, Mostert M, Galletto P, Gastaldo L. Is thrombocytopenia suggestive of organism-specific response in neonatal sepsis? Pediatrics 2009; 51:206-10. [PubMed]
41. Benjamin DK, Ross K, McKinney RE, Benjamin DK, Auten R, Fisher RG. When to suspect fungal infection in neonates: clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase negative staphylococcal bacteremia. Pediatrics. 2000; 106:712–718.
CITATION
DOI: 10.17511/ijmrr.2015.i2.026
Published: 2015-03-31
How to Cite
1.
Rabindran R, Parakh H, JK R, Reddy P. Comparative Study of Platelet count and C-Reactive Protein among Gram Positive, Gram Negative and Fungal Sepsis in Newborns. Int J Med Res Rev [Internet]. 2015Mar.31 [cited 2024Nov.23];3(2):149-56. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/202
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