Septic workup-CRP???

  1. 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
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    About babies_r_us

    Joined: Dec '02; Posts: 32
    staff RN in OB


  3. 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
  4. by   lily0004us
    129 . . . wow! A high CRP value is indicative of an inflammatory response. I think a normal CRP is <1. Even if the CBC and diff were normal and the patient was not symptomatic, I have a strong feeling our physicians would have repeated the CRP. And yes, we do get a CRP when we suspect sepsis.
    Last edit by lily0004us on Dec 21, '02
  5. by   babies_r_us
    The physician did repeat the CRP the next day and it was down to 48 without any meds. The baby was discharged on day 2 and so far so good. Makes me nervous to ignore such a high level.
  6. by   dawngloves
    With those perameters we would have started abx after doing a workup. The results would have determined how long of a therapy. Obviously if no growth, low CRP and WBCs then only a 48 hour course.
    I would still think that baby ruled in with a CRP of 48. But on a decline with no abx? Head scratcher for me.
  7. by   dawngloves
    You guys made me think. Do you all include a LP as part of yor workup? We do it on all ours and I think it is a little excesive.
  8. by   cindyln
    We do not routinely do an LP.
  9. by   NicuGal
    Only certain attendings order CRP's. Some believe that if a baby is stressed it causes a high level, others believe any high level is treated. Luck of the month. But GBS isn't something we mess with...we have a baby now on the unit that came from another hospital that is truly devasted because of GBS sepsis and meningitis.

    We don't do routine LP's was overkill. Only if the baby grows out some odd organisim or becomes worse. Untreated GBS always buy one though.

    It sounds like trouble. We just had a herpes kid whose virus was latent for 2 weeks! And GBS can kill within hours.
  10. by   babies_r_us
    We did not do a LP on that baby. We don't do them very often at all. If baby starts running a fever and we have a history, then they are more likely to do one. So basically only do if baby is really symptomatic, otherwise just do blood work. This same physician also wonders if vacuum extraction or circumcision can cause an elevated CRP. There is no documentation to support this, but a vacuum certainly causes inflammation......something else to think about. What do you guys think??
  11. by   Mimi2RN
    I have never heard of a CRP so high. With that, Hx of GBS and PROM, that baby was a candidate for 3 days of abx at our hospital, pending blood cultures.
    Were cultures done on this baby?

    We have had 35 week twins crump at a week of age because of herpes, almost lost the little girl.
    Last edit by Mimi2RN on Dec 23, '02
  12. by   babies_r_us
    We did 2 sets of cultures and both were negative. I think the other 3 physicians that work at our hospital would have treated the baby. But since it dropped drastically without any intervention, maybe we are overtreating.....just hate to take the chance on a little baby. They can go downhill so quickly. Merry Christmas everyone!!!
  13. by   prmenrs
    We started doing this about 4-5 years ago because of a research protocol, now it's done fairly routinely.
  14. by   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 <1.8. Usually have to have 3 normals to d/c abx.