Using CRP in neonatal practice

C-reactive protein (CRP) is the most widely used infection marker in neonatal practice. Combined with difficulty in early recognition of neonatal sepsis, the number of infants with risk factors for infection, and postnatal maladaptation of non-infectious origin; CRP is often used as a decision making tool for antibiotic therapy. We wished to examine practice regarding neonatal infection and use of CRP.

We designed an online multiple choice questionnaire, asking senior clinicians for their response to realistic postnatal ward scenarios.

We had 91 replies, showing a great degree of variation, with no pattern emerging for experience, region, or even individual neonatal units. This was true even for situations covered by the guidelines that have an evidence basis.

A recurring theme was duration of antibiotic therapy for an elevated CRP, and once levels are falling, when it is safe to stop treatment. Given a lack of good quality evidence, the National Institute of Clinical Excellence (NICE) guidelines are purposefully non-specific. Further research is required, and if incorporated in future national guidelines, should help promote more widespread use and so reduce potential over- and under-treatment of this patient subset. However, this also requires a greater willingness on the part of pediatricians to ensure practice is evidence based.