Value of a single C-reactive protein measurement at 18 h of age
Bibliographic record
Abstract
OBJECTIVE: To evaluate the usefulness of a single C-Reactive Protein (CRP) measurement at 18 h of age to identify neonates where antibiotics started for possible early onset sepsis (EOS) could safely be discontinued. DESIGN/METHODS: In a prospective cohort of 647 preterm (<35 weeks) and 555 late preterm (35-36 weeks) or term newborns with maternal and/or neonatal risk factors for EOS, CRP levels were measured between 15 and 21 h of age. RESULTS: There were 16, 107 and 1079 neonates with proven EOS, possible EOS and no EOS, respectively. Among the 645 neonates with a CRP<10 mg/L, 1 had proven EOS, 43 had possible EOS and 601 (93.2%) were not infected. All with possible or proven EOS were either less than 35 weeks' gestation, symptomatic at the time of CRP assessment or remained on antibiotics because of maternal bacteraemia: they would therefore not be considered for discharge. There were 557 neonates with a 18-h CRP ≥ 10 mg/L. Of these, 15 had proven EOS, 64 had possible EOS, and 478 (85.8%) were not infected. Sensitivity and specificity of 18-h CRP for proven or possible EOS were 64% (95% CI 56 to 73) and 56% (95% CI 53 to 59), respectively. The negative predictive value was 93% (95% CI 91 to 95), and the positive predictive value was 14% (95% CI 11 to 17). CONCLUSIONS: The duration of antibiotic treatment in neonates born beyond 34 weeks' gestation and asymptomatic at the time of CRP assessment could be potentially reduced with a diagnostic algorithm that includes a point-of-care 18-h CRP measurement. An elevated 18-h CRP in isolation should not be used as a reason to prolong antibiotics.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".