Keane Michelle, Fallon Rachel, Riordan Andrew, Shaw Ben
Neonatal Unit, Liverpool Women's Hospital, Liverpool, UK.
Department of Paediatric Infectious diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Acta Paediatr. 2015 Jul;104(7):e289-93. doi: 10.1111/apa.12978. Epub 2015 Apr 1.
A serious inflammatory process is suspected when C-reactive protein (CRP) is very high, and we established the causes and outcomes when CRP was >100 mg/L in neonates.
We retrospectively reviewed all 277 episodes where CRP exceeded 100 mg/L between January 2007 and December 2011 at a tertiary neonatal unit.
Of the 6025 neonates admitted during the study period, 258 had CRP >100 mg/L at least once. The overall mortality rate was 44/258 (17%); 36 died within 7 days of CRP >100 mg/L, and 34 were extremely preterm infants. CRP exceeded 100 mg/L in 106 infants within the first 3 days of life - 74 term, 25 preterm and seven extremely preterm - with no infection identified in 81%. In contrast, infections were found in 87% of the 171 episodes from day four of life - 129 extremely preterm, 23 preterm and 19 term - predominantly coagulase-negative staphylococcus sepsis and necrotising enterocolitis.
Markedly elevated CRP in the first 3 days of life was most likely to affect term neonates (74/106) with no infectious cause (81%). However, CRP >100 mg/L from the fourth day of life was most likely to affect extremely preterm neonates (129/171) and have an infectious cause (87%).
当C反应蛋白（CRP）非常高时怀疑存在严重炎症过程，我们确定了新生儿CRP>100mg/L时的病因及结局。
我们回顾性分析了2007年1月至2011年12月在一家三级新生儿病房中CRP超过100mg/L的所有277例病例。
在研究期间收治的6025例新生儿中，258例至少有一次CRP>100mg/L。总死亡率为44/258（17%）；36例在CRP>100mg/L后7天内死亡，34例为极早产儿。106例婴儿在出生后3天内CRP超过100mg/L，其中74例足月儿、25例早产儿和7例极早产儿，81%未发现感染。相比之下，在出生后第4天起的171例病例中，87%发现感染，其中129例极早产儿、23例早产儿和19例足月儿，主要为凝固酶阴性葡萄球菌败血症和坏死性小肠结肠炎。
出生后3天内CRP显著升高最有可能影响无感染病因（81%）的足月儿（74/106）。然而，出生后第4天起CRP>100mg/L最有可能影响极早产儿（129/171）且存在感染病因（87%）。
