Background and Aims
Preterm infants are susceptible to early-onset sepsis (EOS). The presence of maternal risk factors and/or symptoms often results in antibiotic treatment in the first three days of life. We evaluated the diagnostic test accuracy of C-reactive protein (CRP) levels 12-72 hours after the onset of treatment in very low birth weight (VLBW) infants.

Method
We performed a retrospective study at a Dutch neonatal intensive care unit. We included all VLBW infants born between January 2010 and December 2015 who were treated for a suspected early-onset neonatal infection. Based on blood-culture results, neonates were categorised into two groups: proven sepsis and no proven sepsis. Sensitivity, specificity and predictive values were calculated for CRP levels > 10 mg/l between 12 and 72 hours after initiation of treatment.

Results
In total 914 infants were included. Twenty-five were classified as proven sepsis (E.coli [n=9], group B streptococci [n=9] and others [n=7]). Specificity and negative predictive value (NPV) of CRP were high (77.1%; 98.6%); whereas sensitivity and positive predictive value (PPV) were low (60.0%; 6.8%). In ten neonates with a proven bacterial infection, CRP levels remained below 10 mg/l even 12-72 hours after the start of antibiotics. 

Conclusion
Although the NPV for EOS is very high; culture proven sepsis does quite often not result in a raised CRP level. Therefore, low CRP levels should not be used as a single marker for guidance of antibiotic therapy in VLBW infants with suspected EOS.

06 - THE ROLE OF C-REACTIVE PROTEIN IN THE DIAGNOSIS OF EARLY-ONSET SEPSIS IN VERY LOW BIRTH WEIGHT INFANTS