Role of Sepsis Screen Parameters in Early Diagnosis of Neonatal Septicemia

Lazarus, Monica; Riti, J. Seth; Amit, B. Kinnare

doi:10.20546/ijcmas.2018.701.290

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…However, there are some screening tests (WBC, Platelets, Micro Erythrocyte sedimentation rate(ESR), Absolute Neutrophilic Count (ANC), C-Reactive Protein (CRP), (I/T) ratio, nitroblue teterazolium (NBT), serial Interleukin-6 (IL-6) and pro-calcitonin) that could predict sepsis within 6 to 8 hours 7. The ANC(<1000/ul) and the I/T ratio(≥ 0.2)give the clue about the early-onset sepsis in newborns 8. Rapid diagnostic tests like CRP, WBC indices may be used as a screening approach for early diagnosis and treatment of sepsis 9…”

Section: Introductionmentioning

confidence: 99%

Immature to total neutrophil ratio as an early indicator of early neonatal sepsis

Saboohi¹,

Saeed²,

Khan³

et al. 2019

Pak J Med Sci

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Background & Objectives: Neonatal septicemia is responsible for 1.5 to 2.0 million deaths/year in the under developed countries of the world. Pakistan is number three among these countries and accounts for 7% of global neonatal deaths. The objective of the study was to determine the role of simple hematological parameter, immature to total neutrophil ratio (I/T ratio) in diagnosing early onset neonatal bacterial infection. Methods: A descriptive cross-sectional study was conducted in Neonatal Intensive Care Unit of Liaquat College of Medicine & Dentistry (LCMD) Hospital from January 2016 to January 2017. A total 85 neonates were admitted with clinical suspicion of presumed early onset sepsis or who had potential risk factors for sepsis like prematurity, prolonged rupture of membranes was carried out. After taking informed consent from parents of admitted neonates, data was collected in a structured questionnaire. Laboratory workup included White blood cell count, CRP, absolute neutrophil count, immature neutrophil count while blood C/S was kept as gold standard. Empirical antibiotics started after sample collection for workup. Manual differential count and immature neutrophil count of the peripheral blood smear was performed by a senior technician masked to clinical information. I/T ratio was calculated from WBC, neutrophils and immature neutrophil count by a simple formula. Results: Out of 85 neonates, 13 had positive blood cultures (15.29%). The mean white blood count was 18761.18 ± 8570.75 and mean I/T ratio was 0.1622 ± 0.0419.About 50% of proven sepsis cases had WBC higher than 26000 as compared to 50% of cases for negative diagnoses that had WBC <15500 . The mean I/T in positive CRP 0.204 ± 0.04 was non-significantly higher as compared to negative CRP 0.151 ± 0.034 (p =0.084). Point biserial correlation revealed that I/T ratio was significant strong correlation (rpb = 0.721, p < 0.001) and overall I/T ratio was a good indicator of a positive and negative blood culture result. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of I/T ratio were 76.47%, 83.82%, 54.16% and 93.44% respectively. Similarly majority of neonates having high I/T ratio also depicts positive C-reactive protein (CRP) (NPV 91.23%). Therefore, both I/T and CRP showed a high negative predictive value (I/T = 93.44% and CRP = 91.23%) in this study. Conclusion: I/T ratio is a useful tool for early onset sepsis (EOS) with reasonable specificity but cannot be relied upon as sole indicator. Combination of normal immature to total neutrophil Ratio with negative CRP values in neonates with presumed sepsis is an indicator of non-infected neonate which comprised 78.8% of our study population. How to cite this:Saboohi E, Saeed F, Khan RN, Khan MA. Immature to total neutrophil ratio as an early indicator of early neonatal sepsis. Pak J Med Sci. 2019;35(1):241-246. doi: https://doi.org/10.12669/pjms.35.1.99 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Introductionmentioning

confidence: 99%

Immature to total neutrophil ratio as an early indicator of early neonatal sepsis

Saboohi¹,

Saeed²,

Khan³

et al. 2019

Pak J Med Sci

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“…Also Monica et al (20) detected in their study that CRP is good diagnostic and therapeutic tool and it has high sensitivity and good protective value. On the other hand Markic et al (21) concluded that in spite that CRP are used in the laboratory evaluation of patients with suspected infection or sepsis, however it is still not always possible to accurately predict the presence of bacterial infection on the basic of clinical appearance and those laboratory tests.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Polymorphnuclear Leucocyte Elastase as Diagnostic Tool in Neonatal Sepsis

Abdelrahim

Morsy²,

El-Nagar³

et al. 2018

The Egyptian Journal of Hospital Medicine

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Objectives: Neonatal sepsis is clinical syndrome of bacteremia with systemic signs and symptoms. Neonatal sepsis is still a leading cause of mortality in neonatal intensive care units all over the world. Early diagnosis and treatment of the newborn infant with suspected sepsis are essential to prevent severe and life threatening complications. Objective: The aim of this study was to evaluate polymorph nuclear (PMN) leucocyte elastase as a diagnostic tool in neonatal sepsis. Subjects and Methods: This study was conducted on 45 full term and preterm neonates suspected as neonatal sepsis compared to 45 apparently healthy neonate with matched age and sex, as a control group. Results: 55.6% of our patients group were full-term patients and 44.4% were preterm. All the patients were subjected to full history taking, full clinical examination, lab investigation including CBC, CRP, blood culture and sensitivity, and measurement of serum polymorph nuclear leucocyte elastase enzyme. Conclusion: Significant elevation of serum polymorph nuclear leucocyte elastase level in neonatal sepsis with high specificity.

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“…Based on their clinical symptoms and blood test results, we divided the newborns into two groups: those with unlikely sepsis and those with probable or proven sepsis. A positive blood culture result indicated proven sepsis, whereas a negative finding with clinical symptoms (e.g., ongoing temperature instability, shortness of breath, chest wall retraction, desaturation, or neurologic symptoms not explained by other conditions) or abnormal laboratory data findings (white blood cell count <5000/μL or white blood cell count 6 h after birth >32,000/μL, absolute neutrophil count <1000/μL, C-reactive protein >1 mg/dL, ratio of immature to total neutrophil count >20% [ 11 , 12 , 13 , 14 , 15 , 16 ]) indicated probable sepsis. The rest of the newborns were included in the unlikely sepsis group.…”

Section: Methodsmentioning

confidence: 99%

Relationship between Maternal Fever and Neonatal Sepsis: A Retrospective Study at a Medical Center

et al. 2022

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Various risk factors are associated with neonatal sepsis; however, its relationship to maternal postpartum fever is unknown. This study aimed to determine the relationship between maternal postpartum fever and neonatal sepsis. Full-term and late preterm stable infants born from January 2019 to June 2021 and whose mothers developed intra- or post-partum fever were included in the study. After the newborns were transferred to the nursery, laboratory assessments were performed. Based on clinical conditions and data, the newborns were divided into unlikely sepsis and probable/proven sepsis groups. Maternal fever onset, duration, and maximum body temperature were recorded. We included 1059 newborns whose mothers developed fever intra-partum (n = 192), post-partum (n = 844), and intra- and post-partum (n = 23). The newborns were grouped into those with unlikely sepsis (n = 550) and those with probable/proven sepsis (n = 509). The incidence of intrapartum fever was higher in the probable/proven sepsis group than in the unlikely sepsis group (27.9% vs. 13.3%, p < 0.001). The incidence of postpartum fever was lower in the probable/proven sepsis group than in the unlikely sepsis group (74.7% vs. 88.5%, p < 0.001). Development of maternal fever within 1.8 h postpartum and a newborn respiratory rate of >60 breaths/min were positive predictors (91.6%) for neonatal probable/proven sepsis.

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Role of Sepsis Screen Parameters in Early Diagnosis of Neonatal Septicemia

Cited by 6 publications

References 13 publications

Immature to total neutrophil ratio as an early indicator of early neonatal sepsis

Immature to total neutrophil ratio as an early indicator of early neonatal sepsis

Evaluation of Polymorphnuclear Leucocyte Elastase as Diagnostic Tool in Neonatal Sepsis

Relationship between Maternal Fever and Neonatal Sepsis: A Retrospective Study at a Medical Center

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