Masters Degrees (Paediatrics and Child Health)

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Browsing Masters Degrees (Paediatrics and Child Health) by browse.metadata.advisor "Du Preez, Miemie"

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    Does a serum C-Reactive Protein of less than 10mg/l predict the absence of Early Onset Neonatal Sepsis?
    (Stellenbosch : Stellenbosch University, 2018-03) Wentzel, Bradley Carl; Du Preez, Miemie; Kling, Sharon; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    Abstract: The identification of early onset neonatal sepsis (EONS) remains a challenge. EONS carry a high case fatality. Balanced against this, the unnecessary use of antibiotics carries a high risk in neonates. It has cost implications, increases the risk for necrotising enterocolitis, late onset sepsis, can prolong hospitalisation and changes the microbiome. The use of biomarkers would be useful if this proves to be accurate. The aim of this study was to assess if a serum C-reactive protein (CRP) <10mg/l, measured within the first 36 hours of life predicted the absence of EONS in a high-risk group of neonates admitted to a tertiary hospital in a middle-income country. Material and Methods: The study was performed in the neonatal wards of Tygerberg Hospital during the period 1 January 2014 to 31 December 2014. It was a retrospective study that used a stratified randomisation method. Included in the study were neonates with risk factors for EONS and a CRP less than 10mg/l in whom a blood culture was performed. Results: 138 neonates were admitted to the study (mean birth weight 1 828 ±787 grams, gestational age 32 ± 3.9 weeks). The commonest indications for admission were Spontaneous Preterm Labour (SPTL) (46%), Respiratory Distress Syndrome (RDS) (17%) and Prolonged Preterm Rupture of Membranes (PPROM) (12%). 22% (n=30) of neonates were born to HIV-infected mothers. Surfactant replacement therapy was administered to 19% of the neonates. A serum CRP <4mg/l was present in 91% (n=125) and >4mg/l in 8% (n=13). An organism was isolated from the blood culture specimens in 2 (1.4%) of the cases. Both organisms were most likely contaminants when the clinical course of the neonates was considered. A serum CRP < 4mg/l when compared to a CRP >4 but <10mg/l did not differ in its ability to identify EONS. Conclusion: Our results are limited by the small sample size and the low occurrence rate of pathogen positive blood cultures in our neonatal population. In our study population, we had 2 infants from whom a contaminant was cultured. A quality improvement intervention targeting blood sampling technique and sterility measures may be of benefit. This study supports current practice at Tygerberg Hospital where a neonate suspected of having EONS; who has a CRP level < 10mg/l, taken between 12 and 36 hours and clinically well; antibiotics can be stopped.