Septic workup-CRP??? - page 2
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... Read More
Dec 26, '02Joined: May '02; Posts: 154; Likes: 3We do CRP's along with CBC and BC. We do LP's to follow-up on Staph+ cultures.
Dec 28, '02Joined: May '02; Posts: 278; Likes: 5We 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 <1. Highest I've seen is 18.
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....
Jan 2, '03Occupation: Level II Nursery RN Joined: Aug '01; Posts: 265; Likes: 3Originally 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
Jan 3, '03Occupation: RN, L&D, nursery, post-partum, women'shealth Joined: Apr '02; Posts: 1,581; Likes: 18okay, 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.
Jan 3, '03Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,419; Likes: 3,760C-reactive protein. Can't recall what it IS, but I'll look it up.
Jan 3, '03Occupation: Re-retired Specialty: 42 year(s) of experience in NICU, Infection Control ; From: CA, US ; Joined: Dec '00; Posts: 12,419; Likes: 3,760c-reactive protein is an abnormal protein produced in the liver in response to an acute inflamation. Nl is <.8mg/dl. It is more sensitive than the ESR test. It is used to look for infection, also trauma, transplantation, and connective tissue disease like arthritis.
Jan 3, '03Occupation: Level III NICU Specialty: NICU ; From: US ; Joined: Oct '00; Posts: 1,605; Likes: 929My 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.
Mar 17, '03Occupation: RN NICU Joined: May '02; Posts: 2I 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.
Mar 17, '03Occupation: RN-Retired Specialty: 27 year(s) of experience in NICU ; From: US ; Joined: Jul '02; Posts: 1,400; Likes: 163Reading 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 <1. Maybe dividing it by 6, it would be 21.5, which would still be high to not treat, but sounds a little better. Then it came down to 8, which we would still treat. Do you look at band counts on your diffs, too?
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!