Immature-to-total neutrophil ratio as an early diagnostic tool of bacterial neonatal sepsis

Abstract

Background Bacterial sepsis is the main cause of morbidity and mortality in neonates. Early diagnosis and appropriate treatment for the condition can reduce mortality rates. Blood cultures are the gold standard to diagnose bacterial sepsis, but they require 3-5 days for results, whilst the disease may progress rapidly in neonates. Examination of immature-to-total neutrophil ratio (I/T ratio) in peripheral blood smears is a quicker and less expensive method to diagnose bacterial sepsis in neonates. Some studies found the sensitivity of I/T ratio to be 88%-90% in predicting bacterial spesis.Objective To assess the usefulness of the I/T ratio as an early diagnostic tool for neonatal bacterial sepsis.Methods This cross-sectional study was conducted from February to March 2011. Subjects were collected by consecutive sampling. Fifty-three neonates suspected to have bacterial sepsis in the Perinatology Unit at H. Adam Malik Hospital were included. Subjects underwent routine blood examinations, C-reactive protein level measurements, blood cultures, and peripheral blood smears. All statistical analyses were conducted with SPSS (version 16.0 for Windows).Results Of the 53 subjects, 26 had bacterial sepsis based on blood cultures. The I/T ratio had a sensitivity of 88.46%, specificity 81.84%, positive predictive value 82.14%, and negative predictive value 88%. The receiver operating characteristic curve showed a cut-off point of 83.3 (95%CI 71.3 to 95.3)%.Conclusion The I/T ratio may be a good alternative to blood cultures as an early indicator of bacterial neonatal sepsis, as it is faster, less expensive and has good sensitivity and specificity.

Validity of neutrophil lymphocyte count ratio in neonatal sepsis

“…The sensitivity of the three examinations is quite good, I/T ratio has shown a sensitivity of 88.46%; and specificity of 81.48%, CRP has sensitivity of 88.5%, specificity of 83.3%, and PCT has sensitivity of 92.6% and specificity of 97.5%. Procalcitonin is a very specific and sensitive indicator of neonatal sepsis, which can only be examined after the baby is 3 days old or more (Darnifayanti et al, 2015;Loni et al, 2016;Memar et al, 2017). Unfortunately, all of the laboratory procedure mentioned above require high cost and not readily available in every healthcare facilities, especially in peripheral areas.…”

Ceftazidime as an empiric therapy for neonatal sepsis

“…In their study, 23 subjects had positive blood cultures; IT ratio had a sensitivity of 88.46%. 16 In this study, leukopenia (10/49; 20%) was more frequent than leukocytosis (7/49; 14%). A study in Guangzhou City reported that leukopenia was found in 35% of neonatal sepsis patients compared to leukocytosis in 4% of patients.…”

Role of Immature/Total Neutrophil Ratio, Leukocyte Count and Procalcitonin in Diagnosing Neonatal Sepsis

“…By using a cut-off of I/T ratio > 0.15 in California, was obtained a sensitivity of 89% and a specificity of 94%. 23 I/T ratio could be used as a dignose instrument for early diagnosis of bacterial sepsis in neonates because I/T ratio had a high sensitivity and specificity. In this study, out of 59 samples, showed a sensitivity and specificity of I/T ratio manually by 69.2% ,and 83.9%, 63.9% PPV, NPV 87% 69.2% ,and 83.9%, 63.9% PPV, NPV 87% and LR of 3.06.…”