Role of Micro ESR in the Evaluation of Neonatal Sepsis

Abstract

INTRODUCTION: In a developing country like Nepal, where proper medical care and obstetrical facilities are still scarce in the rural areas, neonatal sepsis is a major cause of neonatal morbidity and mortality. With limited resources, early diagnosis and treatment if crucial, may not be achieved. Objective of this study is to evaluate the role of micro ESR in the diagnosis of neonatal sepsis.
 MATERIAL AND METHODS: A prospective analytical study was done where all neonates with suspected sepsis admitted in NICU were included in the study. Micro-ESR was measured with relevant septic screening investigations. The micro-ESR was compared with age specific cut off value and the results were compared with various clinical presentations, laboratory findings and outcome variables.
 RESULTS: Out of 250 neonates, micro-ESR was elevated in 12% (29 neonates) of cases. Total proven sepsis is 6%, probable sepsis 60.8% and no sepsis in 33.2%. Correlation of elevated micro ESR was statistically significant with presence of clinical symptoms, clinical and systemic signs. It had significant clinical association with blood culture and CSF findings. The sensitivity, specificity and positive and negative predictive value of micro ESR compared to blood culture was 93.3%, 93.6%, 48.3% and 99.5%.
 CONCLUSION:- Micro ESR is a simple, relatively cheap and sensitive study in prediction of neonatal sepsis. It can be useful test in settings with limited resources.

Economic and Diagnostic Biomarker Tests of Neonatal Sepsis: A Prospective Study from a Tertiary Care Hospital in a Low-Income Country

“…Therefore, we added the test to our study. In our study, the median micro-ESR was 6.5(IQR =3-14); although the statistical association was not found as an alternative in diagnosis and in monitoring therapeutic progress [69,70]. Similar studies done in Nepal and India have shown the significance of micro-ESR levels concerning confirmed sepsis: Manandhar et al from Nepal found 17.3% of culture-confirmed sepsis had elevated ESR by 33.3%, while Ghaliyaz et al from India found 32% of culture-confirmed sepsis had elevated ESR by 38% [70,71].…”

Micro-Erythrocyte Sedimentation Rate in Neonatal Sepsis of a Tertiary Hospital: A Descriptive Cross-sectional Study

“…A study done by Kafe R et al in Universal College of Medical Sciences, Bhairahawa, Nepal found 6% of babies with confrm sepsis and 12% had elevated micro –ESR level. 18 Similarly, a study done by Ghaliyah AZ et al in Yenepoya Medical College Teaching Hospital, Mangalore, India found 32% confrm sepsis with a 38% elevated micro-ESR level. 4 In our study also 13 (17.3%) babies had confrmed sepsis and a total of 25 (33.3%) babies had raised micro-ESR level showing the signifcance of micro-ESR level concerning confrm sepsis.…”

“…However, these tests are not easily available in our country and also not cost-efective. 18 Apart from other septic screening tests mentioned in Box 1, micro ESR is a single, cheap, easy to perform, less time consuming with sensitivity and specifcity of 63.3 % and 60% respectively. 19…”

Ceftazidime as an empiric therapy for neonatal sepsis

“…13 Micro-ESR increased in 13/49 (26%) subjects. This result was higher than reported by Kafle et al 14 who found increase micro-ESR in 29/250 neonates (12%), while West et al 15 found that 406 neonates with sepsis, 251 (61.8%) subjects with increase micro-ESR (sensitivity of 75.7%) in the diagnosis of neonatal sepsis.…”