Does the delivery mode affect post-birth neonatal serum C-reactive protein levels? A causal effect analysis

Area of Science:

• Neonatal Medicine
• Biochemistry
• Obstetrics

Background:

• Neonatal serum C-reactive protein (CRP) is a key biomarker for inflammation and infection.
• Understanding factors influencing early neonatal CRP levels is crucial for diagnosing conditions like early-onset neonatal sepsis (EONS).
• Delivery mode is a potential confounding factor in interpreting neonatal CRP levels.

Purpose of the Study:

• To investigate the causal effect of delivery mode on neonatal serum CRP levels.
• To quantify the magnitude of this effect if it exists.
• To inform clinical interpretation of CRP in neonates based on delivery method.

Main Methods:

• Retrospective analysis of 440 neonates' laboratory records.
• Utilized statistical tools combining classical and machine-learning methods for causal inference.
• Conducted sensitivity analysis to assess the impact of unobserved bias.

Main Results:

• Neonates born via elective caesarean delivery had 50% lower serum CRP levels compared to those born via vaginal delivery (P=0.030).
• No significant difference in CRP levels was observed between urgent caesarean delivery and vaginal delivery (P=0.887).
• Results were robust to unobserved bias and consistent when analyzing samples collected later (12-24h).

Conclusions:

• Elective caesarean delivery is associated with significantly lower neonatal CRP concentrations in the first 6-8 hours of life compared to vaginal delivery.
• Delivery mode should be considered when interpreting neonatal CRP levels, particularly for EONS detection.
• Further research incorporating delivery mode is recommended for improved EONS diagnostic strategies.