Diagnostic utility of haematological parameters and C-reactive protein in early detection of neonatal septicaemia in developing countries

Abstract

Introduction: Septicaemia is one of the major causes of mortality and morbidity during the neonatal period especially in developing countries. Early diagnosis of neonatal sepsis is a diagnostic problem due to non-specific clinical features. Blood culture is the gold standard, but it takes several days and is expensive. Hence there is a critical need for laboratory tests that aid in the rapid diagnosis of neonatal sepsis. Aims and Objectives: To measure the role of Haematological Scoring System and C-reactive protein as an early diagnostic tool for neonatal sepsis. Materials and Methods:This was a prospective study performed on 116 neonates, who were clinically suspected cases of septicaemia, admitted at Neonatal Intensive Care Unit, Yenepoya Hospital, Mangalore. Each hematologic parameter like total leukocyte count, polymorphonuclear neutrophil (PMN) count, immature PMN count, platelet count etc. were analysed in all cases using the Haematological Scoring System (HSS) formulated by Rodwell et al. Blood cultures were performed as a gold standard. C-reactive protein (CRP) was also estimated. Results: Out of 116 neonates, 61(52%) were male neonates and 55(48%) were female neonates. 18(15%) cases were with proven sepsis, 58(50%) cases with probable sepsis and 40(35%) cases were on the safer side. The HSS was found to have a sensitivity of 94.4%, specificity of 75.5%, positive predictive value was 41.4% and negative predictive value was 98.6%. Conclusions: HSS is a rapid, simple and easily affordable screening tool for early detection of neonatal septicaemia. It also provides an effective guideline to make decisions regarding judicious use of antibiotics.

Utility of Hematological Parameters in Early Diagnosis of Neonatal Sepsis in Comparison to C-Reactive Protein

“…In this study, TLC had a sensitivity of 35.3%, specificity of 77.1%, NPV of 85.3%, and a PPV of 24%. These results are comparable with studies performed by Nayak et al 12 and Makadia and Shah. 13 In this study, HSS had a sensitivity of 64.7%, specificity of 15.7%, NPV of 68.4%, and a PPV of 13.6%.…”

“…These results are comparable with studies performed by Nayak et al 12 and Sundarapandian et al 16 In addition, a few other studies showed that nRBC count is also increased in neonatal sepsis. 12,17 nRBC count in a term neonate is said to increase in hypoxia, severe anemia, acute stress, and sepsis. In neonatal sepsis, nRBC count is increased due to release of cytokines and is independent of hypoxia.…”

“…In this study, I:T ratio had a sensitivity of 94.1%, specificity of 46%, NPV of 83.3%, and a PPV of 17%. These results are comparable with studies performed by Nayak et al 12 and Sundarapandian et al 16 In addition, a few other studies showed that nRBC count is also increased in neonatal sepsis. 12,17 nRBC count in a term neonate is said to increase in hypoxia, severe anemia, acute stress, and sepsis.…”

“…In our study, we found that among the various hematological parameters analyzed, I:T ratio was a better predictor of neonatal sepsis. Similar results were noted in other studies conducted by Nayana and Sreenivas, 11 Nayak et al, 12 and Makadia and Shah 13 (►Table 2).…”

“…13 In this study, HSS had a sensitivity of 64.7%, specificity of 15.7%, NPV of 68.4%, and a PPV of 13.6%. The obtained sensitivity and NPV of HSS are comparable with similar other studies performed on neonatal sepsis by Nayak et al 12 and Makadia and Shah. In this study, I:T ratio had a sensitivity of 94.1%, specificity of 46%, NPV of 83.3%, and a PPV of 17%.…”