Prognostic value of red cell distribution width in neonatal sepsis in patients admitted at Assiut University Children Hospital

Abstract

Background Sepsis accounts for 40% of neonatal emergencies and is a leading cause of neonatal mortality and morbidity. Patients and methods This prospective observational study was conducted at Neonatal Intensive Care Unit of Assiut University Children Hospital. Aim The aim of the study was to detect the prognostic value of red cell distribution width (RDW) in cases of neonatal sepsis. The study enrolled all patients with neonatal sepsis who were admitted at Neonatal Intensive Care Unit in Assiut University Children Hospital in period between July 2019 and June 2020. The study was approved by the Ethical Committee of Scientific Research, Faculty of Medicine, Assiut University, with IRB no. 17100401. Informed consent was taken from the patients’ parents. All neonates were full-term and subjected to the following: complete history taking and clinical examination for signs of sepsis, severe sepsis, or septic shock. Complete blood count, with differential leukocytic count; C-reactive protein (CRP); blood, cerebrospinal fluid, and urine cultures; and RDW were done for all enrolled neonates. Results Neonates with septic shock had significantly higher CRP (61.81±35.50 g/dl) in comparison with each of those with sepsis (23.66±24.90 g/dl) or severe sepsis (48.10±27.44 g/dl). It was noticed that mean RDW was significantly higher among neonates with septic shock (18.53±2.63%) in comparison with those with severe sepsis (17.54±2.05%) as well as those with sepsis (15.74±2.12%). RDW had positive significant correlations with CRP (r=0.75, P<0.001) and neutrophil/lymphocyte ratio (r=0.46; P<0.001). At cutoff value greater than 17.2%, RDW had 87% sensitivity and 71.4% specificity in prediction of mortality among neonates with neonatal sepsis, with overall accuracy of 76%. CRP at a cutoff point greater than 27 mg had 80% sensitivity and 63% specificity in prediction of mortality among neonates with neonatal sepsis, with overall accuracy of 68%. Conclusion RDW is a simple and cheap method and can be used for prediction of outcome of neonatal sepsis.