Determinants of acute phase reactant scores in well-appearing neonates with maternal risk factors for neonatal infection.

Aim: Approximately 99% of neonatal deaths from sepsis occur in low-to middle-income countries, highlighting the need for efficient screening tools. The Acute Phase Reactant (APR) score comprises C-reactive protein, α1-acid glycoprotein, and haptoglobin, and can be assessed using a latex agglutination kit without modern equipment and expertise. This study assessed APR-score inter-rater reliability and identified non-infectious independent variables associated with positive APR scores in well-appearing term neonates with maternal risk factors for neonatal infection.

Methods: APR scores were assessed within 24 h of birth in 309 term neonates with maternal premature rupture of membranes, meconium-stained amniotic fluid, or maternal colonization of group B Streptococcus.

Results: Positive APR scores were identified in 29.9%, and the kappa value between the two examiners was 0.94. Positive APR scores were associated with higher gestational age (p = 0.010), female sex (p = 0.001), and meconium-stained amniotic fluid (p = 0.041).

Conclusion: In neonates with maternal risk factors for neonatal infection, a convincingly high interrater agreement was demonstrated in the assessment of the APR score using a latex agglutination kit. Gestational age, sex, and meconium-stained amniotic fluid were identified as non-infectious independent variables associated with positive APR scores. By adjusting for these variables, an APR-based screening algorithm for neonates with sepsis may be established for use in low-resource settings.