Effectiveness of blood tests in differential diagnosing early-onset sepsis in meconium-stained infants

This study aimed to evaluate the effect of intermittent monitoring of C-reactive protein (CRP) and procalcitonin (PCT) in the differential diagnosis between infants with unlikely sepsis and possible sepsis of newborns with meconium-stained amniotic fluid (MSAF).

In this prospective cohort study, full-term infants with MSAF born between January 1, 2021 and December 31, 2021 in our university hospital were evaluated and their CRP and PCT levels were monitored at the postnatal 6, 24, and 48 h.

Newborns with MSAF (n = 65) were divided into two groups: possible sepsis (n = 47, 72%) and unlikely sepsis (n = 18, 28%) groups based on clinical findings, without considering laboratory results. In the univariate analysis, CRP (>15 mg/L, p < 0.001) and PCT values (>2 ng/mL, p = 0.010) at the postnatal 24-h screening and CRP value (>15 mg/L, p = 0.020) at the postnatal 48-h screening were found to be the significant factors in the differential diagnosis of possible sepsis and unlikely sepsis. In the multivariate analysis, only CRP at the postnatal 24-h was found to be associated with the possible EOS (p = 0.001), and the 24-h CRP value above 18.8 mg/L had the highest accuracy.

In a group of MSAF infants, if the CRP value measured at the postnatal 24 h in a full-term newborns with MSAF is above 18.8 mg/L and there are clinical signs of sepsis, it indicates that the possibility of early-onset sepsis is high.