Serial Neutrophil Values Facilitate Predicting the Absence of Neonatal Early-Onset Sepsis

Mikhael, Michel; Brown, L. Steven; Rosenfeld, Charles R.

doi:10.1016/j.jpeds.2013.10.080

Cited by 40 publications

(23 citation statements)

References 25 publications

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“…Although Sepsis-3 concentrates on organ dysfunction in the diagnosis of sepsis, microbiological results are often still included in neonatal sepsis. Blood culture is only positive in approximately 0.5% 11,12 due to the small blood volume for blood cultures and antenatal maternal antibiotic use. There is no reliable single marker of sepsis and mortality and morbidity are high so empiric antibiotics are commenced in infants at risk.…”

Section: Why Neonates Are Differentmentioning

confidence: 99%

Neonatal sepsis: need for consensus definition, collaboration and core outcomes

et al. 2020

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Section: Why Neonates Are Differentmentioning

confidence: 99%

Neonatal sepsis: need for consensus definition, collaboration and core outcomes

et al. 2020

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“…Moreover, 27.6% of infants had an abnormal laboratory finding (abnormal IT ratio and/or abnormal CRP) at 12 hours of life, which according to current COFN guidelines , would require prolonged antibiotics. Recently, Mikhael et al 17 described the use of a neutrophil value score, which evaluates 9 neutrophil indices corrected for postnatal age.…”

Section: Figurementioning

confidence: 99%

Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

et al. 2014

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BACKGROUND AND OBJECTIVE: Chorioamnionitis (CAM) is a major risk factor for neonatal sepsis. At our institution, neonates exposed to CAM and intrapartum antibiotics are treated with prolonged antimicrobial therapy if laboratory values are abnormal despite a sterile blood culture. Recently, the Committee on the Fetus and Newborn (COFN) recommended a similar strategy for treating neonates exposed to CAM. Our objective was to determine the frequency of abnormal laboratory parameters in term and late-preterm neonates exposed to CAM and evaluate the implication of recent COFN guidelines. METHODS: This retrospective data analysis included late-preterm and term neonates exposed to CAM. Laboratory parameters, clinical symptoms and the number of infants treated with prolonged antibiotics were determined. RESULTS: A total of 554 infants met the inclusion criteria. Eighty-three infants (14.9%) had an abnormal immature to total neutrophil ratio (>0.2) and 121 infants (22%) had an abnormal C-reactive protein level (>1 mg/dL) at 12 hours of age. A total of 153 infants (27.6%) had an abnormal immature to total neutrophil ratio and/or abnormal C-reactive protein level at 12 hours of age. Only 4 (0.7%) of 554 infants had a positive blood culture result. A total of 134 (24.2%) infants were treated with prolonged antibiotics (112 [20.2%] were treated solely based on abnormal laboratory data). Lumbar puncture was performed in 120 (21.6%) infants. CONCLUSIONS: When managed by using a strategy similar to recent COFN guidelines, a large number of term and late-preterm infants exposed to CAM who had sterile blood culture findings were treated with prolonged antibiotic therapy due to abnormal laboratory findings. They were also subjected to additional invasive procedures and had a longer duration of hospitalization.

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“…Apart from that, neutropenia which is very common and more sensitive in diagnosis of sepsis has a similar score as leukocytosis which is frequently seen in neonates due to non-specific reasons. 13,14 Recent recognition of role of nucleated RBCs in neonatal sepsis deserves its inclusion in diagnosis of sepsis. The modified HSS designed by us have incorporated the above facts.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have highlighted the diagnostic ability of neutropenia to be higher than leukocytosis in neonatal sepsis. 13,14 Study observed that neutropenia was strongly associated with sepsis and hence deserved a higher weightage. Hence, we increased the weightage to two (instead of one in HSS) of this parameter to obtain the modified HSS (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Modified hematological sepsis score in early diagnosis of neonatal sepsis

Krishnamurthy¹,

Thandaveshwar²,

Doreswamy³

2017

Int J Res Med Sci

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Background: Diagnosis of neonatal sepsis at an early stage substantially reduces the mortality. The clinician often relies on laboratory parameters to support the clinical suspicion. As blood culture takes time and yield is low, hematological and biochemical parameters often guide to the diagnosis and management. Rodwell’s Hematological sepsis score (HSS) has a reasonable sensitivity but low specificity. Some of the parameters included in that scoring system are repetitive of same pathogenic mechanism. A modified HSS was developed by the authors by removing the repetitive parameters, increasing the weightage for low neutrophil count and adding a new parameter - nucleated RBC. Objective of the study was to compare the diagnostic ability of the modified hematological sepsis score with Rodwell’s hematological sepsis score.Methods: Prospective analytical study conducted in a tertiary level hospital. Neonates admitted to NICU and had complete blood count done were included. Babies with clinical signs of systemic inflammatory response syndrome and evidence of organ dysfunction were considered septic. They were classified as proven sepsis if the blood culture was positive. All the samples were scored for both HSS and modified HSS. The sensitivity, specificity and other diagnostic ability tests were compared between the two scoring systems.Results: Total of 75 neonates were enrolled. 25 of them had sepsis and three had blood culture positive. At a score of 3, the sensitivity and specificity of HSS was 80 and 70% and that of Modified HSS was 84 and 82% respectively.Conclusions: Modified hematological score improves the specificity and likelihood ratios without decreasing the sensitivity in early diagnosis of neonatal sepsis.

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Serial Neutrophil Values Facilitate Predicting the Absence of Neonatal Early-Onset Sepsis

Cited by 40 publications

References 25 publications

Neonatal sepsis: need for consensus definition, collaboration and core outcomes

Neonatal sepsis: need for consensus definition, collaboration and core outcomes

Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

Modified hematological sepsis score in early diagnosis of neonatal sepsis

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