Validez de la proteína C reactiva en el diagnóstico precoz de la sepsis neonatal temprana en UCIN I y II del Hospital Víctor Lazarte Echegaray
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Date
2022-12-07
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Universidad Nacional de Trujillo
Abstract
La Sepsis Neonatal es el conjunto de síntomas y signos ocasionados por la invasión y proliferación de agentes infecciosos (bacterias, hongos o virus) a nivel sanguíneo de un recién nacido dentro de sus primeros 28 días de vida. Los hallazgos clínicos y los análisis de laboratorio para detectar sepsis no se manifiestan inmediatamente, sino que tienen un período latente variable y puesto que puede la Sepsis Neonatal Temprana llegar a ser letal, es importante establecer su diagnóstico precoz para el inicio de antibioticoterapia. Hasta 65%-95% de los pacientes hospitalizados en las Unidades de Cuidados Intensivos Neonatales son tratados como si estuviesen infectados, cuando solo en menos del 5% se llega a confirmar la sepsis. En diferentes estudios se aprecian valores elevados de hemograma, Proteína C reactiva patológicos y cultivos de sangre y/o de fluidos corporales estériles positivos para confirmar “Sepsis Clínica”. Sobre todo, en un neonato con un valor inicial negativo de Proteína C Reactiva se puede concluir con seguridad que no tiene Sepsis Neonatal Temprana con un Valor Predictivo Positivo casi de 99%, es decir; por lo opuesto, es difícil interpretar los valores positivos, incluso si son mayores de 10 – 12 mg/L.
Es por ello que se pondrá en investigación la validez de la Proteína C Reactiva cuantitativa en el diagnóstico precoz de sospecha de Sepsis Neonatal Temprana en Unidad de Cuidados Intermedios Neonatales I y II del Hospital Víctor Lazarte Echegaray, EsSalud, Trujillo.
Objetivo: Determinar la sensibilidad y especificidad de la Proteína C Reactiva en el diagnóstico precoz de sepsis neonatal temprana en neonatos atendidos en la Unidad de Cuidados Intermedios Neonatales ya mencionadas.
Método: Se realizará una investigación descriptiva, observacional, retrospectivo y analítica de Proteína C Reactiva. Se analizará datos e información de Recién Nacidos con sospecha clínica de Sepsis Neonatal Temprana hospitalizados en las Unidades de Cuidados Intermedios ya mencionadas – durante el período 2021-2022. Para ello se considerarán historias clínicas de recién nacidos a término nacidos en Hospital Víctor Lazarte Echegaray, de recién nacidos con diagnóstico presuntivo de Sepsis Neonatal con edad menor a 3 días de vida, y con recién nacidos a quienes se les realizó Proteína C Reactiva cuantitativa y hemocultivo antes del inicio del tratamiento antibiótico.
Transversal: Se realizará la obtención de datos en un solo momento.
Retrospectivo: Se realizará la obtención de datos de los diversos pacientes atendidos en el período 2021-2022.
Muestra: El tamaño de la muestra será conveniente, se evaluará 270 historias clínicas de RN con diagnóstico presuntivo de SNT nacidos en Hospital Víctor Lazarte durante el período 2021-2022 que corresponden al 100% de la población del servicio de Neonatología en estudio.
Neonatal Sepsis is the set of symptoms and signs caused by the invasion and proliferation of infectious agents (bacteria, fungi or viruses) in the blood of a newborn within the first 28 days of life. Clinical findings and laboratory tests to detect sepsis do not manifest immediately, but have a variable latent period and since Early Neonatal Sepsis can become lethal, it is important to establish its early diagnosis for the initiation of antibiotic therapy. Up to 65%-95% of patients hospitalized in Neonatal Intensive Care Units are treated as if they were infected, when only less than 5% are confirmed with sepsis. In different studies, high blood count values, pathological C-reactive protein and positive sterile blood and/or body fluid cultures were observed to confirm "Clinical Sepsis". Above all, in a neonate with a negative initial value of C-Reactive Protein, it can be safely concluded that he does not have Early Neonatal Sepsis with a Positive Predictive Value of almost 99%, that is; on the contrary, it is difficult to interpret positive values, even if they are greater than 10 – 12 mg/L. For this reason, the validity of quantitative C-Reactive Protein in the early diagnosis of suspected Early Neonatal Sepsis in the Neonatal Intermediate Care Unit I and II of the Víctor Lazarte Echegaray Hospital, EsSalud, Trujillo, will be investigated. Objective: To determine the sensitivity and specificity of C-Reactive Protein in the early diagnosis of early neonatal sepsis in neonates treated in the Neonatal Intermediate Care Unit. Method: A descriptive, observational, retrospective and analytical investigation of C-reactive protein will be carried out. Data and information from Newborns with clinical suspicion of Early Neonatal Sepsis hospitalized in the aforementioned Intermediate Care Units – during the period 2021-2022 – will be analyzed. To this end, clinical records of full-term newborns born at the Víctor Lazarte Echegaray Hospital, newborns with a presumptive diagnosis of Neonatal Sepsis with an age of less than 3 days of age, and newborns who underwent quantitative C-Reactive Protein and blood culture before the start of antibiotic treatment will be considered. Cross-sectional: Data will be collected at a single time. Retrospective: Data will be collected from the various patients treated in the period 2021-2022. Sample: The sample size will be convenient, 270 clinical histories of newborns with a presumptive diagnosis of TNS born at Hospital Víctor Lazarte during the period 2021-2022 will be evaluated, corresponding to 100% of the population of the Neonatology service under study.
Neonatal Sepsis is the set of symptoms and signs caused by the invasion and proliferation of infectious agents (bacteria, fungi or viruses) in the blood of a newborn within the first 28 days of life. Clinical findings and laboratory tests to detect sepsis do not manifest immediately, but have a variable latent period and since Early Neonatal Sepsis can become lethal, it is important to establish its early diagnosis for the initiation of antibiotic therapy. Up to 65%-95% of patients hospitalized in Neonatal Intensive Care Units are treated as if they were infected, when only less than 5% are confirmed with sepsis. In different studies, high blood count values, pathological C-reactive protein and positive sterile blood and/or body fluid cultures were observed to confirm "Clinical Sepsis". Above all, in a neonate with a negative initial value of C-Reactive Protein, it can be safely concluded that he does not have Early Neonatal Sepsis with a Positive Predictive Value of almost 99%, that is; on the contrary, it is difficult to interpret positive values, even if they are greater than 10 – 12 mg/L. For this reason, the validity of quantitative C-Reactive Protein in the early diagnosis of suspected Early Neonatal Sepsis in the Neonatal Intermediate Care Unit I and II of the Víctor Lazarte Echegaray Hospital, EsSalud, Trujillo, will be investigated. Objective: To determine the sensitivity and specificity of C-Reactive Protein in the early diagnosis of early neonatal sepsis in neonates treated in the Neonatal Intermediate Care Unit. Method: A descriptive, observational, retrospective and analytical investigation of C-reactive protein will be carried out. Data and information from Newborns with clinical suspicion of Early Neonatal Sepsis hospitalized in the aforementioned Intermediate Care Units – during the period 2021-2022 – will be analyzed. To this end, clinical records of full-term newborns born at the Víctor Lazarte Echegaray Hospital, newborns with a presumptive diagnosis of Neonatal Sepsis with an age of less than 3 days of age, and newborns who underwent quantitative C-Reactive Protein and blood culture before the start of antibiotic treatment will be considered. Cross-sectional: Data will be collected at a single time. Retrospective: Data will be collected from the various patients treated in the period 2021-2022. Sample: The sample size will be convenient, 270 clinical histories of newborns with a presumptive diagnosis of TNS born at Hospital Víctor Lazarte during the period 2021-2022 will be evaluated, corresponding to 100% of the population of the Neonatology service under study.
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Keywords
Proteína C-Reactiva, Sepsis Neonatal, Diagnóstico Precoz