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Early postnatal C-reactive protein elevation during initial hospitalization in neonates with giant omphalocele
Zilu Huang1, Yanfen Peng1, Junjian Lv1
1Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
Serum C-reactive protein (CRP) levels remain elevated in neonates with giant omphalocele (GO) after delayed repair, but this elevation does not strongly indicate infection. Careful interpretation of CRP is crucial to avoid unnecessary antibiotic use in GO infants.
Area of Science:
- Neonatal Surgery
- Pediatric Infectious Diseases
- Clinical Chemistry
Background:
- Giant omphalocele (GO) is a complex congenital anomaly requiring surgical intervention.
- Delayed repair is sometimes necessary for GO management, posing unique challenges in the neonatal period.
- Serum C-reactive protein (CRP) is a common biomarker for inflammation and infection, but its interpretation in GO neonates needs clarification.
Purpose of the Study:
- To describe the dynamic changes in serum C-reactive protein (CRP) in neonates with giant omphalocele (GO) undergoing delayed repair.
- To analyze the clinical characteristics associated with CRP levels in the early postnatal period.
- To investigate the correlation between CRP elevation and proven infection in these infants.
Main Methods:
- A retrospective study of 15 neonates with GO who underwent delayed repair.
- Serum CRP levels were measured at multiple time points post-birth (0, 5, 7, 10, 14, 21 days).
- Data on hospital stay, complications, and antibiotic treatment were collected and analyzed.
Main Results:
- Serum CRP peaked around day 5 post-birth and remained elevated for weeks, showing a decreasing trend.
- Peak CRP levels positively correlated with hospital stay duration (R=0.78, p=0.001).
- Despite high CRP, proven infection was low (20%); prolonged CRP elevation was linked to larger defects and longer recovery times.
Conclusions:
- Neonates with GO and delayed repair show significant, prolonged CRP elevation in the early postnatal period.
- This CRP elevation has a poor correlation with confirmed infection, suggesting non-infectious causes.
- Clinicians should exercise caution in interpreting CRP in GO neonates to prevent overuse of antibiotics.
Introduction:
To preliminarily describe the dynamic changes and clinical characteristics of serum C-reactive protein (CRP) in giant omphalocele (GO) neonates with delayed repair during the early postnatal period.
Methods:
A retrospective study included 15 neonates with GO who underwent delayed repair at our hospital. CRP was collected at 0, 5, 7, 10, 14, 21 days after birth and before discharge. Data on hospital stay duration, complications, and anti-infection treatment were recorded. Descriptive statistics were used to present the trend of CRP changes, and the relationship with clinical indicators was preliminarily analyzed.
Results:
Among the 15 full-term neonates (average gestational age 38.5 weeks, birth weight 2,821 g), CRP reached a peak value on the 5th day after birth (median 87.1 mg/L), followed by a decreasing trend but remaining at a high level (78.0, 67.2, and 48.0 mg/L on the 7th, 10th, and 14th days, respectively). The peak CRP level was positively correlated with the hospital stay duration (R = 0.78, p = 0.001). 73.3% (11/15) of the GO neonates received empirical antibiotic treatment (average course of 11 days), while the pathogen positivity rate was only 20% (3/15), and all were cultured from the sac membrane secretions. Based on the duration of continuous CRP elevation as the classification criterion, it was found that neonates with a longer duration of elevated CRP had larger defects, longer hospital stays, and longer time to achieve full enteral nutrition.
Conclusion:
Neonates with GO undergoing delayed repair exhibit significant CRP elevation in the early postnatal period, but this rise correlates poorly with proven infection. Clinicians need to carefully interpret the changes in CRP and avoid excessive anti-infection treatment. This retrospective study provides preliminary data and hypothesis basis for subsequent large-sample studies.
