The comparison of the tollner score with crp and leukocyte count in the diagnosis and follow-up of neonatal sepsis

Newborn sepsis is clinical syndrome which occurs during the first month of life with bacteriemia and accompanied by systemic findings of infection. The incidence of neonatal sepsis is 1-8/1000 live births. It makes this problem more important as there are difficulties in diagnosis; current clinical discoveries are nonspesific and mortality and morbidity increases caused by delay in treatment. New and effective laboratory tests are needed in the diagnosis of neonatal sepsis. However, today, high sensitivity and specificity of any test which can be used in the diagnosis of neonatal sepsis in the early period has not been found yet. For this reason, many hematological and biochemical diagnostic parameters especially CRP are being researched either alone or together for their effectiveness in the diagnosis.In this study we studied all term and preterm newborns who scored 5 and above according to the ?Töllner Sepsis scoring system? in the Newborn İntensive Care Unit at University of Afyon Kocatepe Faculty of Medicine, Education and Research Hospital between July 2009 and July 2010. Blood culture was taken from all patients. Study group consisting of 40 patients whose hemoculture is positive or clinically diagnosed with sepsis and control group consisting of 40 patients whose hemoculture is negative and sepsis is eleminated were choosen. In both groups CRP, WBC values and Töllner sepsis scores were taken before starting treatment, after treatment in the 72nd hours and seventh to tenth days and they were compared with each others.Sepsis group included 40 patients and from this group 24 of them (60%) were male and 16 of them (40%) were female and from 40 patients of control group 21 of them (52,5%) were male and 19 of them (47,5%) were female. From 40 sepsis patients 18 of them were accepted (45%) as early sepsis, and 22 of them (55%) as late newborn sepsis. Patients with sepsis were found to have a mortality rate of 10%. From these 3 of them (16,7%) were early sepsis and 1 of them (4,55%) was late sepsis patients.Among 40 patients with sepsis 17 of them (42,5) blood cultures were positive. In both groups, the more agent in positive blood cultures was Klebsiella pneumonia. It was been found that hemoculture positive patients with sepsis the most Töllner sepsis score increases (>10) happened with 76,5%. After that followed by 70,6 % high I/T ratio, 64,7% high CRP, 32,5% leukocytosis or leucopenia.During evaluation of responses to the treatment CRP and WBC values, which are measured serially of sepsis group were found higher than control group. There were not statistically significant difference among WBC values (p>0.05) of the sepsis group, however, there were statistically significant difference among CRP values (p<0,05). Moreover, the decrease of CRP levels was determined day by day. It was found that sensitivity of CRP was 67,5%, specifity 77,5%, the positive predictive 75% and the negative prediktivite 70,5% in the diagnosis of neonatal sepsis.It was found that Töllner sepsis scoring system wasn?t enough parameter by itself in diagnosis and follow-up of neonatal sepsis but would become useful when it was used with CRP together and hematological parameters ( WBC, I/T ratio and trombositopeni). It was found that CRP serial measurement would be more significant in the evaluating of responses to the treatment.