Utility of Hematological Parameters in Detection of Neonatal Sepsis

Abstract

Background: Sepsis in neonates may be difficult to differentiate from other conditions because the clinical signs are non specific. The hematological response to inflammation in neonates includes many changes in the form of an abnormal total count, morphological changes, thrombocytopenia and various inflammatory markers in serum. Aim and Objectives: To assess the importance of hematological profile in early diagnosis of neonatal sepsis and to calculate the sensitivity, specificity and predictive values of individual hematological tests and various test combinations. Material and Methods: It was a prospective study including 128 neonates, out of which 65 were cases (31 proven septic and 34 probable cases; blood culture being the gold standard) while rest 63 were controls. They were evaluated for sepsis using hematological scoring system (HSS) and c-reactive protein (CRP). Parameters used in score were Immature: Total polymorphonuclear cell (I:T) and Immature: Mature polymorphonuclear cell (I:M) ratio, Total White blood cell (WBC) count, Total Polymorphonuclear (PMN) cell count, Immature Polymorphonuclear cell count, Platelet count and degenerative changes observed in neutrophils. Results: Blood culture was positive in 31 cases. Preterm infants and low birth infants were more prone to sepsis. I: T ratio, total PMN count, I:M ratio and Immature PMN count were found to have high sensitivity while degenerative changes in PMN was found to be highly specific test for sepsis along with 2 total WBC count. Applying c test, the association of sepsis was found to be significant with I:T ratio, I:M ratio, Immature PMN count, Total WBC count, Platelet count and positive CRP test. As the Hematological score increased from 1 to 6, sensitivity and negative predictive value decreased and vice-a-versa happenedwith specificity and positive predictive value. Conclusion: HSS has high sensitivity and specificity, the certainty of sepsis being present with higher scores and using combination of various parameters. Hence, it may aid the clinicians in identifying sepsis and to start proper and timely antibiotic therapy.

Keywords

• Neonatal Sepsis
• Hematological Score System
• Rural Set Up