Diagnostic utility of Haematological scoring system (HSS) with clinicopathological and bacteriological evaluationin early diagnosis of neonatal sepsis

Abstract

Background: Neonatal sepsis is a major cause of mortality with high incidence of 11 to 24.5 per 1000 live births in India. Delay in diagnosis further increases the mortality to 30-40% of total neonatal deaths. Though blood culture is gold standard for diagnosis of neonatal sepsis, it has limitations. The comprehensive Hematologic scoring system (HSS) formulated by Rodwell et al is used for early diagnosis of sepsis. This comprises of Immature/Total neutrophil ratio, Total PMN count, Immature/Mature ratio, Immature PMN count, degenerative changes in PMN, platelet count.Methods: This is a prospective study of haematologic profiles of 303 neonates All neonates with congenital abnormalities diagnosed at birth admitted in neonatal care unit in our institute. Field stained blood smears were examined for HSS. Blood culture was done before administration of antibiotic treatment. Neonates with predisposing perinatal risk factors or if there was clinical suspicion of sepsis were included in this study from Nov 2014 to feb 2016. Result:Of the 303 neonates in the present study, 77 had positive blood cultures, The incidence of septicemia was higher in males (72.7%) than females (27.3%). Majority of the neonates presented with early onset type of sepsis (91%). Elevated I: T ratio and I:M ratio were seen in most cases of septicemia. Conclusion:HSS is the most sensitive indicator of sepsis. Use of HSS by peripheral smear study Blood culture can be used effectively as a sepsis screen for early diagnosis is useful to reduce neonatal morbidity and mortality.

Hematological Profile of Newborns Hospitalized for Neonatal Bacterial Infection in the Neonatology of the Pediatric Department of Gabriel Toure Teaching Hospital Bamako, Mali

“…In our study, more than the majority (64.8% were premature and 35.2% of children born are full term). This susceptibility of premature newborns was found by Bhagyashree M [21]. Clinically, the main manifestations were respiratory and neurological signs.…”

“…In literatures, the first clinical manifestations of neonatal bacterial infection very generally appear before the 72nd hour of life. What is found by Bhagyashree M. [21]. Premature babies are more susceptible to infection than those born at term because of their weak immune systems, low immunoglobulin levels, low skin barrier, and low birth weight [22].…”

“…Which shows that thrombocytopenia is a sign of gravity. It is frequently associated with severe sepsis and its association with the clinical picture constitutes a poor prognosis [21] [31]. This is explained by an increased destruction of platelets by sequestration secondary to infections and/or by a decrease in production secondary to the suppression of the bone marrow.…”

“…This is explained by an increased destruction of platelets by sequestration secondary to infections and/or by a decrease in production secondary to the suppression of the bone marrow. It has a high sensitivity and specificity [21] [24] [31].…”

Neonatal sepsis: A review of the literature

“…Traditionally, the definition of sepsis has included the isolation of a pathogen from a normally sterile body fluid such as blood or cerebrospinal fluid (CSF) [4,5]. However, given the understanding of the role of potent pro-inflammatory cytokines in the clinical characterization of sepsis, the term 'Systemic Inflammatory Response Syndrome (SIRS)' has also been used to define sepsis in neonates [2,4].…”