Role of platelet count and CRP level in gram negative versus gram pos itive bacterial sepsis in low birth weight neonates

Objective Bacterial sepsis is a common complication in the neonatal intensive care unit. Identification of bacteria by laboratory culture is difficult and may take a few days. Thus there is need for an alternative early valid marker of sepsis. Elevated levels of C-reactive protein and thrombocytopenia are common findings in neonatal sepsis. Based on the staining properties & cell wall morphology bacteria are divided into Gram positive & Gram negative. Whether these properties of different species of bacteria, have differential effect on depletion of platelets and elevation of CRP is not clear. In the light of lack of this data, this study was undertaken to identify the most common bacteria causing sepsis and their relations to thrombocytopenia and C-reactive protein in neonates. Methods Inl03 neonates with culture proven sepsis, C- reactive protein & platelet count were noted. Platelet count > 100,000/mm³ of blood was considered as thrombocytopenia. C- reactive protein > 10 mg/L was considered as CRP positive cases. Data analysis was done using Analysis of variance and Unpaired Student's 't' test. Results Among the 103 detected cases, 87 (84. 47%) were Gram negative and 16 (15. 53%) were Gram positive. Thrombocytopenia was detected in 82. 75% of neonates infected with Gram negative bacteria. Platelet count was within normal limit in the entire Gram positive infected neonates studied. Mean platelet count was significantly less in neonates infected with Gram negative organisms compared to Gram positive infected neonates (0. 675 ± 0. 341 vs. 1. 985, P <0. 0001). Platelet count did not differ significantly among different species of Gram negative bacteria. CRP was above 10 mg/L in all the 103 cases studied. Mean CRP of Gram negative infected group did not differ significantly compared to Gram negative group (76. 18 ± 18. 02 vs. 70. 25 ±21. 47, t = 1. 17, P = 0. 24). Conclusion In low birth weight neonatal sepsis Gram negative infection is more common and thrombocytopenia is a characteristic feature. CRP is a non-specific indicator of neonatal sepsis.