Septic workup-CRP???

[babies_r_us]

Just a question about the labs everyone does for a septic workup on a baby. Is anyone doing CRP's routinely as part of the workup? We just had a physician order one and it came back positive with a level of 129 (normal is less than 6) and she chose not to treat the baby. There was also a history of GBS and possible prolonged ROM (pt reported leaking for days and physician said "not rupt" at office without over doing a fern test or nitrazine....then no fluid at delivery). Anyway, our physician said since baby looked good and CBC was normal, she wasn't going to believe the CRP!?!?! Then why the heck are they ordering tests if they are going to ignore the results. I think we are asking for a lawsuit if we get abnormal labs and choose to ignore them because "they are inaccurate!" I keep waiting for that baby to be readmitted to Peds. Any comments on what you guys do?? thanks

[IttyBittyBabyRN]

We do CRPs on anyone with any risk of infection upon admission and it's our first check whenever a baby starts having increased desats, etc. Can't say I've ever seen one that high!! Normal to us is

[nurseiam]

We do CRP's along with CBC and BC. We do LP's to follow-up on Staph+ cultures.

[nell]

We do CBC at birth and CBC, CRP at 12and 24 hrs on any kid that fits our protocols (PROM >18 hrs, GBS+, Maternal temp, etc). CRP > 2.5 gets teated, CRP > 4 buys LP too. Normal CRP for us us

I was told circs don't cause more than a level of 1, don't know about vacuum, we've had lots of vacuum kids without positive CRPs.

I'd be worried about that kid too....

[BBnurse34]

Originally posted by cindyln

We do cbc and blood cultures.If the baby is looking the least bit symptomatic we start antibiotics until the blood cultures come back

Us too.

[ShandyLynnRN, BSN, RN]

okay, as a nurse in L&D, postpartum, AND nursery, I guess I should probably need to know: WHat is a CRP? I work at a small hospital, level 1...don't believe I've ever heard of it.

[prmenrs, RN]

C-reactive protein. Can't recall what it IS, but I'll look it up.

[prmenrs, RN]

c-reactive protein is an abnormal protein produced in the liver in response to an acute inflamation. Nl is <.8mg it is more sensitive than the esr test. used to look for infection also trauma transplantation and connective tissue disease like arthritis.>

[KRVRN, BSN, RN]

My understanding is since a CRP can also be elevated d/t inflammation, then it is only a possible indicator of infection. If the CRP stays under 1 than we feel certain the kid isn't septic (UNLESS the baby acts sick otherwise). A level of 129 or 48 would raise eyebrows but if the baby isn't acting sick otherwise and the CBC is normal I have a feeling we would question it too.

We don't do routine LP's. Kids with positive blood cx always get them, same with any kid that starts seizing. Readmits from home with FUO usually get them too.

Many of us have a problem getting readmits from home for anything besides hyperbili. Just hope we never have an undiagnosed chicken pox ravage all our preemies.

[unzen]

I believe the CRP results can be elevated due to stress of delivery and can be elevated in a neonate less than 72hrs (I think) if the mom's immunity was stressed before delivery. (i.e. had infection such as this particular mother had.). This elevation can give a false indication of infection. At our hospital, the docs don't order or want a CRP drawn unless a infant was otherwise healthy and then started to look/ act sick. I don't think the doc ignoring a very high, out of parameter CRP was the wrong thing to do on a newly delivered infant whose CBC was normal. The fact that a follow up CRP was ordered shows the doc wasn't ignoring it completly. Not starting ABX on the baby makes me wonder though, unless the maternal Hx showed adequate treatment before delivery.

[Mimi2RN, ASN, RN]

Reading this thread again, it made me wonder about the lab parameters. If normal is less than 6 and the baby was 129, what would it be if it should be

To me it's worth treating a baby for three days, than having it deathly ill at home.

We had one admitted to peds at 4 days with B-strep meningitis, had 25 days of abx. We rarely hear the f/u, though.

That ped was pushing his luck not treating the baby!