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Clinical applications of C-reactive protein in pediatrics
1Department of Pathology, University of Alabama at Birmingham 35233, USA.
Insights
Serial C-reactive protein (CRP) measurements effectively monitor pediatric treatment response for infections, inflammation, surgery, and burns. However, CRP alone lacks data for guiding antimicrobial therapy decisions or diagnosing specific pediatric conditions.
Area of Science:
- Pediatric Medicine
- Clinical Chemistry
- Infectious Diseases
Background:
- The use of C-reactive protein (CRP) measurement in pediatrics is expanding.
- CRP offers potential advantages over Erythrocyte Sedimentation Rate (ESR) in various clinical applications.
Purpose of the Study:
- To evaluate the utility of serial CRP measurements in pediatric patient monitoring.
- To assess the role of CRP in guiding therapeutic decisions and differential diagnosis in children.
Main Methods:
- Review of existing literature on CRP applications in pediatric populations.
- Analysis of data regarding CRP's effectiveness in monitoring treatment response, disease recurrence, and differential diagnosis.
Main Results:
- Serial CRP measurements are valuable for monitoring responses to therapy in invasive infections, inflammatory diseases, post-surgical patients, and burn victims.
- CRP monitoring can help detect disease recurrence, secondary infections, or inadequate treatment.
- Current data do not support using CRP alone for initiating, withholding, or discontinuing antimicrobial therapy in suspected neonatal sepsis, meningitis, bacteremia, or pneumonia.
- CRP shows inconsistencies in differentiating bacterial vs. viral diseases and is not recommended for diagnosing acute appendicitis or localizing urinary tract infections.
Conclusions:
- Serial CRP measurements are a useful tool for monitoring pediatric patients with specific conditions.
- CRP is not currently recommended as a standalone diagnostic or management tool for several critical pediatric infections or conditions.
Abstract:
The body of literature concerning studies of the applications of CRP measurement in the pediatric population continues to grow. Based on current data serial CRP measurements appear to be most useful for monitoring patient response to therapy after the primary diagnosis of invasive infectious or inflammatory diseases, for monitoring patients after major surgical procedures and those with serious burns. Monitoring CRP over time may be used to assess for recrudescent disease, a secondary process or ineffective therapy. In addition CRP appears to be suited to most applications for which the ESR is used but offers many advantages. At present there are no objective outcome-based clinical trial data to justify using CRP values alone, whether elevated or normal, as a basis for management decisions regarding instituting or withholding antimicrobial therapy, or its early discontinuance for patients suspected of having neonatal sepsis, meningitis, bacteremia or pneumonia, regardless of immune status. In addition, because of significant inconsistencies among studies for which CRP has been applied to differential diagnosis of bacterial vs. viral diseases, including meningitis, acute otitis media and lower respiratory tract infection, we cannot recommend it for this purpose. Data do not support a role for CRP in differential diagnosis of acute appendicitis or for localizing urinary tract infections.