Aim Meconium-stained amniotic fluid (MSAF) is seen in approximately 13% of all deliveries and may complicate the differential diagnosis of early-onset sepsis (EOS). This study aimed to evaluate the effect of intermittent monitoring of C-reactive protein (CRP) and Procalcitonin (PCT), in the differential diagnosis between infants with unlikely sepsis and possible sepsis of newborns with MSAF.

Material and Method In this prospective cohort study, full-term infants with MSAF born between January 1, 2021, and December 31, 2021, in our university hospital were evaluated and their CRP and PCT levels were monitored at the postnatal 6th, 24th, and 48th-hours.

Results Of the 65 patients evaluated, 18 (27.6%) were classified in the group of possible sepsis and 47 (72.4%) in the group of unlikely sepsis exclusively according to their clinical signs. 78% (14/18) of the cases with possible EOS were born by cesarean section (p=0.025). In the univariate analysis, CRP (>15 mg/L, p<0.001) and PCT values (>2 ng/ml, p=0.010) at the postnatal 24th-hour screening, and CRP value (>15 mg/L, p: 0.020) at the postnatal 48th-hour screening were found to be the significant factors in the differential diagnosis of possible sepsis and unlikely sepsis. In the multivariate analysis, only CRP at the postnatal 24th-hour was found to be associated with the possible EOS (p=0.001), and the 24th-hour CRP value above 18.8 mg/L had the highest accuracy (sensitivity and specificity 83% and 85%, respectively) (table 1).

Conclusions In a group of MSAF infants, we have demonstrated the value of intermittent CRP and PCT monitoring in the differential diagnosis of clinically classified unlikely sepsis from possible sepsis, and the highest accuracy, especially if the 24-hour CRP value is above 18.8 mg/L.